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Planter fasciatis .pptx
- 1. PLANTAR FASCIITIS By Sai KumarPatel BPT 3rd year
- 2. INTRODUCTION ● Plantar fasciitisis one of the most common causes of heel pain. ● Structure of foot allows to sustain the large weight bearing stress under a variety of surface and activities .
- 3. DEFINITION ● Plantar fasciitisis a painful condition caused by inflammation of Plantar fascia.
- 4. Anatomy :- ● Plantarfascia is a dense , fibrous Connective tissue structure originating from the medial tuberosity of the calcaneus. ● The actual purpose of Plantar fascia is :- ■ Support for the arch ■ Act as shock absorber ■ Dynamic function during gait
- 5. Epidemiology/Incidence:- ● Most commonin sports that involve , long distance walking, dancers , tennis players, basket ball players. ● Non-athelets whose occupation requires prolong weight bearing.
- 6. Etiology :- 1. Overweight 2.Running on Hard surface 3. Pesplanus , pescavus ( congenital problem) 4. Improper foot wear 5. Decreased First MTP Joint extension 6. Heel pronation 7. Prolonged standing 8. Poor intrinsic muscle strength 9. Tibialis posterior weakness
- 7. Pathophysiology:- Plantar fasciitis injury:- ● Repetitive impact on the feet for long time cause flexor Muscles/tendons to become short and tight. ● Micro tearing at the point of attachment cause progressive scarring of tissue, inflammation and pain. ● Over a period of time heel spur may develop.
- 8. Clinical Features :- ●Pain at base of heel ● Pain severe on getting out bed /mornings & in the beginning of a run . ● Tenderness bottom of foot , burning pain , often sharp pain ● Swelling of bottom of foot ● Limp may be present
- 9. Differential diagnosis:- ● Plantarfasciitis is most common cause of chronic plantar heel pain there are multiple differential diagnosis : ■ plantar fascia rupture ■ Heel fat pad syndrome ■ Calcaneal stress fracture ■ Calcaneal bursitis ■ Achilles tendonitis
- 10. Plantar fascia rupture Heel fatpad syndrome Achillis tendonitis
- 11. Calcaneal stress fractureCalcaneal bursitis
- 12.
- 13. MANAGEMENT :- ■ Conservativemanagement ■ Surgical management
- 14. CONSERVATIVE MANAGEMENT :- ●Anti inflammatory drugs , cortisone injections ● NSAIDS ○ IBUPROFEN ○ NAPROXEN ■ Medical management:-
- 15. ● Surgical releasewith plantar fasciotomy: done open or arthroscopically ● Surgical release with plantar fasciotomy and distal tarsal tunnel Surgical management :-
- 16.
- 17. Subjective assessment :- ■Demographic data/patient profile:- ● Name :- ● Age :- PF is most common between the ages of 40 & 60 years old ● Gender:- ● Occupation:- Assessment :-
- 18. Chief complaints:- ● Painat the bottom of heel ● Pain can be dull or sharp ● Pain is usually worse on getting out bed .
- 19. ● Pain site:- Inferomedial heel pain ● Depth :- deep ● Onset :- gradual & insidious ● Severity :- unbearable , moderate Aggravating factors:- ● Exercises such as running . ● Excessive pronation .
- 20. ● Rest Relieving factors:- Pasthistory :- ● Related to area of complaint. ● Whether the patient met with trauma .
- 21. Objective assessment:- 1. Swelling:- At the bottom of heel 2. Colour changes :- redness 3. Posture :- poor posture 4. Attitude of limb :- foot is overpronated ■ On observation
- 22. ● Temperature :-warmth ● Swelling ● Tenderness:- Anterior medial heel On palpation:-
- 23. On Examination :- ●Pain reproduced by palpating the plantar medial calcaneal tubercle at the site of the plantar fascial insertion on the heel bone . ● Weight-bearing is difficult ,& swelling and ecchymosis in the plantar aspect of foot ● Windlass test ● Squeeze test
- 24.
- 25. ● SHORT TERMGOALS ○ To reduce pain ○ To reduce inflammation ○ To reduce swelling ○ To reduce tenderness
- 27. Cryotherapy:- ● Apply icepack ● Foot massage
- 28. Electrotherapy modalities :- ●Ultrasound therapy ● Phonophoresis ● Contrast bath
- 29. - Talocrural jointposterior glide - Subtalar joint lateral glide ,distraction Manual therapy:-
- 30.
- 31. Therapeutic exercises:- ● Stretchingexercises ● Strengthening exercises
- 32. Stretching exercises:- Calf musclestretching
- 33.
- 34.
- 35. Exercise to controlexcessive pronation ● Improve Tibialis posterior strength ● Improve ankle plantar flexor strength ( heel raise ) ● Improve intrinsic foot muscle strength
- 36. Improve Tibialis posteriorstrength
- 37. Improve intrinsic footmuscle strength
- 38. ● Night splints:- ■ Maintain ankle in neutral position and toes in slight extension
- 39. Orthotic devices :- ●Heel cuffs ● Viscous elastic heel pad ● Accomdative inlays
- 41. ■ Home programshould be prescribed and follow up of patient is done for every 2 weeks .
- 42.