Plantar Heel Pain EXAM 3

Exact etiology is unknown, but may behave more so like an -opathy

What is the etiology of plantar heel pain

- Windlass mechanism

- Ankle/Foot rockers

What mechanism of the foot can influence plantar heel pain

- Limited ankle dorsiflexion ROM

- High BMI in non-athletic individuals

- Running

- Work-related weight bearing activities

What should clinicians assess the presence of during an evaluation for plantar heel pain

dorsiflexion

what ROM is limited when suspecting plantar heel pain

- Waist girth

- Ankle PF strength

- Pain at multiple sites

- Pain catastrophizing

What are risk factors associated with chronic plantar heel pain

- Report pain on plantar aspect of medial heel

- Increased symptoms after period of NWB, improves with increasing activity

- Usually, first step in the morning is very painful

- Returns with repetitive, prolonged activity gradually increases symptoms (e.g., standing, running)

- May report change in shoe wear, concerns for pes planus/heel spurs

What are common history findings in patients with plantar heel pain

Increased symptoms after period of NWB, improves with increasing activity

What is a hallmark sign of plantar heel pain

Plantar medial aspect of the calcaneus (plantar fascia insertion)

with plantar heel pain, where is the specific location of maximal palpation tenderness

active/passive dorsiflexion

1st MP joint extension

Commonly limited ranges of motion (ROM) with plantar heel pain

Positive (+) result; high specificity (Sp) when performed in weight-bearing

windlass test findings with plantar heel pain

Negative tarsal tunnel tests

Status of Tarsal Tunnel tests to support a plantar heel pain diagnosis

TC, STJ, 1st MTP

Joints showing decreased mobility with plantar heel pain (3)

plantar fascia connects to 1st MTP and is related to the Windlass mechanism making it functionally relevant

Why might we want to measure 1st MTP ROM in patients with plantar heel pain

reproduction of the patient's pain at the heel

What is a positive windlass test

- Supine ROM

- MMT

- Standing functional assessment

- Special tests (Windlass, Tinels)

- Palpation

Based on the most recent CPG for Foot and Ankle examination, what should be included in your assessment

- Dorsiflexion

- Plantarflexion

- Supination/inversion

- Pronation/eversion

- 1st MTP extension

- Joint mobility

What ROM measurements may be functionally relevant to plantar heel pain based on the most recent CPG

- Dorsiflexion

- Plantarflexion

- 1st MTP extension

What MMT measurements may be functionally relevant to plantar heel pain based on the most recent CPG

- Heel raise

- Dorsiflexion lunges

- Foot posture index 6

- Single leg squat

- Gait

- Leg length

- Single leg balance

What standing functional assessments may be functionally relevant to plantar heel pain based on the most recent CPG

- screening proximal structures

- lumbar radiculopathy

- tarsal tunnel syndrome

- stress fracture

- fat pad contusion

- nerve entrapment diagnoses of medial and lateral plantar nerves

What is included in the differential diagnosis for plantar heel pain

- Manual therapy (Level A)

- Stretching (Level A)

- Taping (Level A)

- Night Splints (Level A)

- Orthoses (Level B, C)

- Therapeutic Exercise and Neuro Re-Ed (Level B)

- Patient Education (Level E)

What are intervention options for the management of plantar heel pain

key points about manual therapy for the management of plantar heel pain

- Thrust and non-thrust techniques directed at TCJ, STJ, and 1st MTP, and soft tissue structures can decrease pain and improve function (CPG, Grade A)

- MT + stretching shown to improve function and reduce pain at 3, 6, 12, and 52 week follow up

- Continue to use test-retest paradigm

- Best coupled with matched exercise

True

TRUE or FALSE: Plantar heel pain is a Diagnosis you don't need to see the patient a lot for and they will still improve

- Clinicians should use plantar fascia specific and gastroc-soleus stretching to provide short- and long-term pain reduction, as well as short- and long-term disability

- Keeping it simple with minimal exercises can lead to positive results

What are stretching recommendations for patients with plantar heel pain

Anti-pronation taping

for plantar heel pain, _______ taping is for immediate (up to 3 wk) pain reduction and improved function

Elastic therapeutic tape

for plantar heel pain, ________ tape is applied to the gastroc and PF for short term (1 week) pain reduction

Resistance training for the foot and ankle musculature

What should be included in the prescribed exercises for the management of plantar heel pain

- Provide basics of diagnosis, prognosis, and plan of care

- Activity modification

- Weight loss management (Grade E evidence)

- Consider relevant central elements or psychosocial factors

What is to be included in the education for the management of plantar heel pain

- Can be effective for reducing pain and improving function for short (2 weeks) term to long term (~12 months)

- No difference between prefabricated and custom orthoses

- No difference between custom insoles and sham insoles or GP-led usual care (Rasenberg et al 2021)

- May not significantly impact lower extremity kinematics

what are key points about orthotics use for plantar heel pain treatment/management

- Injections > Ortho at 4 weeks, but Ortho > injections at 12 weeks

- No clinical significance between interventions at LT on Foot Health Questionnaire despite being statistically significant

What were the findings of the study comparing the effects of foot orthoses vs. corticosteroid injections for the management of plantar heel pain

- Largely not priority treatment approaches with varied efficacy

- US not recommended for tissue extensibility (Grade A)

- Use of phonophoresis, LLLT dry needling may assist (Grade B - D)

key points about modality use for the management of plantar heel pain

- Ice

- Rolling on ball/water bottle

- Omitted barefoot walking

- Rest/NSAIDS

- Shoe changes

What modalities are generally used/approved for the management of plantar heel pain