Heel pain and Plantar Fasciitis: latest update (2014)
Plantar fasciitis is the most common foot condition and accounting for up to 15% of all adult foot complaints requiring professional care.
Increased plantar fascia thickness is associated with symptoms (altered pain levels) and altered compressive properties of the fat pad in those with plantar heel pain. Heel pain/plantar fasciitis is often see as a chronic condition, with symptom duration greater than 1 year.
Risk factors may include limited ankle dorsiflexion ROM, high BMI in nonathletic individuals, running, and work-related weight-bearing activities. The ICD category of plantar fasciitis and the associated ICF impairment-based category of heel pain (b28015 Pain in lower limb, b2804 Radiating pain in a segment or region).
History and physical examination findings should include:
- Plantar medial heel pain: especially the first steps after a period of inactivity and prolonged weight bearing
- Heel pain provoked by a recent increase in weightbearing activity
- Pain with palpation at the proximal insertion of the plantar fascia
- Positive windlass test
- Negative tarsal tunnel tests
- Limited active and passive talocrural joint dorsiflexion ROM
- Abnormal foot posture index (FPI) score
- High BMI in nonathletic individuals
Diagnostic ultrasound may be used to assess plantar fascia thickness.
Recommendations for treatment are manual therapy treat relevant lower extremity joint mobility and calf flexibility deficits. Treatment to decrease pain and improve function in individuals with heel pain/plantar fasciitis may be considered. The use of plantar fascia–specific and gastrocnemius/soleus stretching to provide pain relief for individuals with heel pain/plantar fasciitis. Strengthening exercises and movement training for muscles that control pronation and attenuate forces during weight-bearing activities should be prescribed.
Heel pads, foot orthoses supporting the medial arch may be used to decrease pain and improve function. Antipronation tape and therapeutic tape applied to the gastrocnemius and plantar fascia may be an option. A 1- to 3-month program of night splints has shown to be an option. Rocker-bottom shoe construction in conjunction with a foot orthosis, and shoe rotation during the work week for those who stand for long periods are options open to the therapist.
Manual therapy, stretching, and foot orthoses is preferred instead of electrotherapeutic modalities. Clinicians may or may not use iontophoresis to provide short-term pain relief and improved function, however phonophoresis with ketoprofen gel may reduce pain The use of low-level laser therapy to reduce pain and activity limitations is warranted
Education and counseling on exercise strategies to gain or maintain optimal lean body mass for individuals with heel pain/ plantar fasciitis.
The use of ultrasound , ESWT and trigger point dry needling cannot be recommended for individuals with heel pain/plantar fasciitis.
These guidelines are not intended to serve as a standard of medical care, but should be considered as a guideline. Clinical procedure or treatment plans must be based on clinician experience and expertise and on the clinical presentation of the patient; the available evidence; the available diagnostic and treatment options; and the patient’s values, expectations, and preferences.
> From: Martin et al., J Orthop Sports Phys Ther 44 (2014) A1-A23. All rights reserved to Orthopaedic Section, American Physical Therapy Association (APTA), Inc, and the Journal of Orthopaedic & Sports Physical Therapy®. Click here for the Pubmed summary.