http://www.ivyrehab.com/2014/04/diagnosis-treatment-plantar-fasciitis/

Diagnosis and Treatment of Plantar Fasciitis

Friday, April 18th, 2014

(c) Can Stock Photo

Plantar fasciitis is one of the most common causes of heel pain.

Plantar fasciitis is a common condition involving pain and inflammation of a thick band of tissue, called the plantar fascia.  The plantar fascia is similar to a bow string which runs across the bottom of your foot and connects your heel bone to your toes. Most people experience a sharp, stabbing pain in the heel.  This commonly occurs with the first steps taken out of bed in the morning, or when getting up from a seated position.   When sleeping or sitting, the plantar fascia becomes tight.  Once you are up and walking, the plantar fascia loosens and the pain normally decreases. Plantar fasciitis can develop as a result of increase or change in activity, weight fluctuation, occupations that require walking or standing on hard surfaces, faulty foot mechanics and faulty footwear.  If tension on the plantar fascia becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed. Plantar fasciitis is most common in women between the ages of 40 and 60, and typically affects one foot. Ignoring the symptoms of plantar fasciitis may result in chronic heel pain. You may also develop foot, knee, hip or back problems from compensating. Minimally invasive procedures include extracorporeal shock wave therapy (ESWT) and radiocoblation (Topaz).   Few people need surgery to detach the plantar fascia from the heel bone. It’s generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.

Physical Therapy Interventions

Physical Therapy is often consulted for patients diagnosed with plantar fasciitis. A good way to think of rehabilitation is in two phases: first, control the symptoms and aggravating factors; second, prevent future re-occurrences. Phase one of physical therapy may include treatments (modalities) such as hot/cold packs, electrical stimulation, or ultrasound; gentle non-weight bearing stretching, and range of motion (ROM) activities. Manual therapy techniques, including joint mobilizations and soft tissue mobilizations are frequently utilized. The Graston Technique, a form of instrument assisted soft tissue mobilization, is a specific type of manual therapy provided by certified Physical Therapists, and is an excellent complement to stretching and strengthening. Education is always provided to prevent daily habits that may be exacerbating symptoms, such as proper footwear and use of ice packs at home. These interventions are all applied with the goal of controlling and eliminating symptoms such as pain and inflammation. Phase two is designed to prevent re-occurrence by eliminating the source of the fasciitis. Many times fasciitis develops due to chronic poor posturing of the foot during weight bearing activities, such as walking. Re-establishing correct foot mechanics, the way in which the foot impacts the floor throughout gait, is critical in preventing future symptoms. Routinely orthotics or proper-fitting shoes are recommended to support unstable (high) arches. Additionally, strengthening and balance training activities are beneficial to ensure proper force transfer through the foot during stance and minimizing stress through the plantar fascia.

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Written By:

Dr. Diana Tsombarsis, DPM

Foot Care Centers

Vineland, NJ

&

Jared C. Mannello, PT, DPT

IvyRehab Director of Rehabilitation

Somers Point, NJ