CONSERVATIVE PHYSICAL THERAPY TREATMENT OF PLANTAR FASCIITIS CONSERVATIVE PHYSICAL THERAPY TREATMENT OF PLANTAR FASCIITIS

IN LONG DISTANCE RUNNERS IN LONG DISTANCE RUNNERS

Poster Presentation by: Shannon Grunerud, Trudi HoImstrom, & JiIIian Johnson (4
th
Year Physio Students - U
of S)
Objectives
1. To identify the common mechanisms of injury causing pIantar
fasciitis in the running popuIation.
2. To identify evidence to support the efficacy of conservative
physicaI therapy treatment techniques for pIantar fasciitis.
Predisposing Factors
It is the most common cause of
pIantar heeI pain. Repetitive
stress to the pIantar fascia origin
Ieads to micro-tearing and
chronic infIammation. TypicaIIy,
pIantar fasciitis pain is worse in
the morning upon weight bearing.
Long distance
runners with pIantar fasciitis experience pain upon
initiation of activity. ShortIy into the run, the pain may
subside onIy to re-occur with greater intensity foIIowing
proIonged weight bearing.
Definition of PIantar Fasciitis
Extrinsic Factors
training errors such as
progressing the running
distance > 32km/week
training on unyieIding
surfaces
change in footwear
improperIy or excessiveIy
worn footwear
change in amount or intensity
of activity
initiation of a new activity
such as running
Intrinsic Factors
excessive pronation
accounts for 81-86% of aII
cases
Iower extremity
aIignment: tibiaI torsion or
femoraI anteversion
decreased pIantar fIexor
extensibiIity and/or
strength
weakness of hip and
Iower extremity
muscuIature
tight hamstrings
Ieg Iength discrepancy
Iimited ankIe dorsifIexion
cavus feet
CIinicaI Practice GuideIines
I. Acute Management Phase (0 - 6
weeks)
A. Reduce Tissue InfIammation and ControI Pain
B. Reduce Stress on Affected Tissues
C. Restore FIexibiIity
Night SpIints - worn for a minimum of 6 hours/night; hoIds the
foot in neutraI or 5 of dorsifIexion.
Stretching Upon Wakening - perform a manuaI stretch before
initiaI weight-bearing in the morning with the foot in
dorsifIexion and use the hand to puII the toes into extension
RoIIing Pin Stretch - roII dorsifIexed foot over cyIinder twice
per day for 5 minutes (see diagram).
Stretches Throughout the Day - incIuding the pIantar fascia
and gastro-soIeus compIex (see diagram).
II. Chronic Management Phase (6-12 weeks)
AppIy heat for 20 minutes 2 times/day before stretching.
Education regarding the biomechanics of the foot, guideIines on return to sport,
prevention of re-injury, and evaIuation of footwear.
Incorporate sports specific activities such as waIk-run progressions.
Proprioception and baIance retraining if needed.
Progress the intensity of the stretching program
III. Cases Non-responsive to Treatment (>12 weeks)
A more invasive treatment such as corticosteroid injection or surgicaI reIease of the pIantar fascia may be
necessary if various forms of conservative treatment techniques faiI.
Stretching and
Night SpIint
Strengthening Exercises
Foot Orthotics - orthotics shouId be custom made. ReferraI to an orthotist is required.
HeeI Cups - used to take the stress off the pIantar fascia.
Continue to use prescribed orthotics and techniques to controI infIammation.
ManuaI Stretch
http://orthaheeI.com/stretches/htmI
http://docortho.com/pIantarfasciitis/nightspIint.htmI
http://www.med.umich.edu/1Iibr/sma/sma_xpIanfas_art.htm
http://www.ourfootdoctor.com/your_pIantarfsciitis.shtmI
HeeI Cups
http://proIine-
supports.com/acataIog/shop_onIine_ HeeI_Cups_183.htmI
PIantar fasciitis is considered a chronic overuse injury.
Rest & Ice - 20 minutes 2 times/day and foIIowing activity or Iong periods of weight bearing.
Educate patient regarding risk of frost bite, reverse effect, etc.
Iontophoresis - 0.4% dexamethasone sodium phosphate 3 times/week. Use a current
maximum of 0.4mA. TotaI charge is 40mAmin over 20 minutes.
UItrasound - 1.0W/cm
2
continuous wave frequency of 1.0 MHz for 5 minutes aIong the
pIantar fascia and inferior heeI 3 times/week.
OR