· condition caused by overuse injury commonly find in middle aged people
· This is the most common cause of heel pain
· Develops as an result of continuous traction forces affecting on planter fasica at origin point over the distal calcaneus
· During the physical examination its important to ask the patient about the things that makes the pain worse or ease the patient situation.
· History of severe sharp pain early in the morning at heel during the first couple of steps or after long non weight bearing intervals.
· Pain & tenderness , mostly on the medial & anterior aspect of caclacneus near the sole of heel are its characteristics features. In case of severity this pain may radiate proximally.
· Along with the pain, there may be an issue of localized heel swelling and foot stiffness.
· Limping is obvious and the toe walking may be preferred by patients.
· Initially there is decrease in pain as the patient begin to walk but it may increase as well as the increase of the activity all over the day.
· Pain may get stronger during barefooted walk on hard surfaces or climbing the stairs.
· When there is less severity, the pain will be loacalized below the heel bone but in more serve cases the pain may be reproduced to the proximal of the planter fascia.
· Tight Achilles tendon may add the severty triggering the limited dorsi flexion
· Other foot problems like pes planus, pes cavus or overpronation can be observed.
· Windlass Test (Passive dorsiflexion of toes)
· During the examination, palpation over the planter medial calcaneal tubercle at point of planter fascia to heel bone , may reproduce the pain of planter fasciitis.
· According to some studies, Sometime patients adopt such walking pattern where they can offload the heel and medial fore foot to compensate and reduce pain
FACTORS WHICH MAY INCREASE THE RISK OF DEVELOPING THESE CONDITIONS
There are many proposed risk factors for plantar heel pain, including
· increased body mass index (BMI),
· limited ankle joint dorsiflexion,
· calcaneal spur,
· leg length discrepancy,
· diminished thickness of heel pad,
· pes planus,
· pes cavus,
· excess pronation and
· limited range of motion of the first metatarsophalangeal joint (MPJ)
· Non surgical treatments include rest, massage therapy, non-steroidal anti-inflammatory drugs, night splints, heel cups/pads, injections, cases and physiotherapy options like sock wave therapy.
· Studies shows that 90% of patients are successfully treated with non surgical management.
· If condition remain same after 6 months of the start of non surgical treatment, surgery is the only option.
· First treatment option for planter fascitis is the orthotic management.
· Orthotics management is low cost, noninvasive and economically more acceptable to the patient.
· The purpose of the orthotic treatment is to adapt the unnecessary mechanical stresses and to prevent the strains due to overloading on planter fascia.
· For the fabrication/selection of orthoses, it is important to consider the structure of the planter arch and the fat pad under the heel. As these are reported as the main contributor factor to increase the strain in the fascia.
· Provision of immediate, intermediate and long term relief is effectively done by the foot orthosis.
· Strong evidence is still require to choose between the prefabricated and customized orthses for such condition to get effective outcomes.
· It is very much needed to get the response of the patients either they we benefited , average or completely not benefited from either of the options..
HEEL CUSHIONS & PADS
Heel pads are usually made up of polyvinyl chloride, silicone, leather, polyethylene foams like Plastizote, and thermoplastics
· Provision of extra shock absorption in the heel area
· Help to shock absorbing during heel stricke and running.
· Soft heel cups cushion containing the fat pad, are effective for a plantar calcaneal bursitis or plantar heel spur syndrome
· Heel cushion made up of silicon has a built-in softer durometer part. The special design is to dissolve weight around the plantar medial tubercle of the calcaneus.
· A slight heel lift not thicker than one quarter inch is some time help fot to shift pressure to forefoot.
· A heel lift is helpful in shifting pressure to the forefoot. Keep in mind that
THE SOFT INSOLE
· with adjusted medial arah support – reduces the tension through out the fascia.
POSTERIOR NIGHT SPLINT
· an ankle-foot orthosis (AFO) positioned in about 5 degrees dorsiflexion.
· only to wear at night.
· To prevent the contractures of Planter fascia at night in result of planter flexed position.