Ortho 2 Exam 2 (LLAF and Shoulder) --> LLAF Conditions (heel spur and plantar fasciopathy)

what is a heel spur

- chronic traction of the plantar fascia on the calcaneal tubercle

- seen commonly with plantar fasciopathy

- associated with pes planus

- abnormal bony growth at the site of an irritative lesion

how do heel spurs present clinically?

- increased pain along medial tubercle of calcaneus with WB

risk factors associated with heel spurs

- female

- increased weight gain

- increasing age

interventions for heel spurs

- heel spur itself isn't the problem, its the traction injury that needs to be addressed

- stretch tight heels

- address compensation

- ensure proper windlass mechanism

what is plantar fasciopathy?

- syndrome that effects 1 in 10 people

- repeated microtrauma at central band of plantar fascia

how does plantar fasciopathy present clinically?

- pain and discomfort at inferior heel

- aggravated with WB after periods of NWB

> most noticeable in the morning with the first few steps

- decreased pronation foot posture

- decreased pain within 30-45 min of WB/activity

- aggravated with prolonged WB

what are extrinsic factors of plantar fasciopathy?

- training errors

- training surfaces

- footwear

what are intrinsic factors of plantar fasciopathy?

- obesity

- cavus foot

reduced PF strength

- reduced DF ROM

what are the 2 strongest intrinsic factors for plantar fasciopathy in non-athletes?

- limited ankle DF

- high BMI

how to diagnose plantar fasciopathy

- symptom reproduction with palpation at medial calcaneal tubercle

- active and passive DF ROM

- tarsal tunnel syndrome test (DF EV --> looking for tinnels)

- windlass test

- longitudinal arch angle

- LEFS

- navicular drop

- pes planus

what are the goals of non-surgical plantar fasciopathy treatment? (3)

- reduce pain and inflammation

- reduce tissue stress

- restore muscle strength and flexibility of involved tissues

what modalities should you use for plantar fasciopathy

- moderate evidence to support dexamethasone ionto

- manual stretching

- orthoses to promote long term improvement functionally

stretching and strengthening management for plantar fasciopathy

- little support for intrinsic muscle strengthening

- moderate evidence for calf stretching for short term relief and improved flexibility

> PF stretching may be more beneficial than PF stretching

- perform calf stretches 2x/day using sustained 3min or intermittent 20sec

nonsurgical taping management of plantar fasciopathy

- anti-pronation taping for immediate pain relief and improved function

- taping is more beneficial when added to a stretching program

nonsurgical orthotic management of plantar fasciopathy

- strong evidence to support the use of foot orthoses that support MLA and cushion the heel area

> no difference between custom and generic

- decreased pain after 2 weeks with orthoses and stretching program

nonsurgical extracorporeal shock wave therapy management of plantar fasciopathy

- ESWT

- low energy shock waves administered through US to the base of calcaneus

- accelerates healing

- useful if pateint is not responding to conservative treatments

T/F: barefoot shoes contribute to plantar fasciopathy?

- false

- no difference between exercising with barefoot shoes and normal shoes on plantar fasciopathy

is dry needling beneficial for plantar fasciopathy?

- limited evidence to support reducing of treatment during using dry needling

nonsurgical management of plantar fasciopathy using low level laser therapy

- LLLT

- can decrease pain and increase activity

are phonophoresis and ultrasound beneficial for management of plantar fasciopathy?

- minimal evidence to support

night splints for plantar fasciopathy

- moderate evidence to support using night splints for patients with symptoms for 6+ months

- typically worn for 1-3 months

is patient education important for plantar fasciopathy?

- yes

- Beischer et al. used a 10min multi-media presentation about

> anatomy

> pathophysiology

> history of PF

> initial treatment

> alternative options

surgical treatment for plantar fasciopathy

- controversial

- fasciotomy and spurectomy

> indicated after 6mo of failed conservative treatment

> can cause MLA collapse, tibial n injury, pain

- gastroc recession (lengthening) --> avoids MLA collapse