1. Plantar Fasciitis Dick Evans PT,OCS

2. Plantar Fascia Thick broad connective tissue that spans the arch of the foot Originates on the medial tubercle of the calcaneus and inserts onto the proximal phalanges and flexor tendon sheaths Forms longitudinal arch of the foot and functions as a shock absorber Supports the arch as weight is transferred over the foot from heel strike to toe off

4. Fasciitis??? A degenerative condition that may or may not be associated with inflammatory changes in the tissues Pain may be caused by repetitive micro trauma to the fascia

5. Frequency Occurs in 10 % of runners and may be associated with training errors Accounts for 11-15% of all foot symptoms requiring medial care

6. Symptoms Classic presentation: heel pain in the morning when first rising from bed May improve through the day but tends to hurt again by afternoon and evening. Reoccurs upon standing after prolonged sitting Worse with walking barefoot and walking up stairs

7. Physical Exam Tenderness to palpation on the anteromedial aspect of the heel Ankle dorsiflexion limited by calf tightness Pain increased by toe extension or by standing on toes

8. Risk Factors Obesity Occupation requiring prolonged standing Pes planus or cavus Calf tightness Toe runners, running up hills or in sand Rapid change in activity level: intensity or duration Lack of warm up or cold weather

9. Differential Diagnosis Tarsal tunnel Bone bruise or heel contusion Sever disease Calcaneal stress fracture Fat pad atrophy / central heel pain Inflammatory arthropathies Neuropathic pain Retrocalcaneal bursitis Achilles insertional pain

10. Prognosis 80% are better in 12 months Surgical intervention is rare

11. Treatment Activity modification Shoe inserts / orthotics / taping / supportive shoes Night splints Stretching program: arch, calf, soft tissue massage, ice Modalities : iontophoresis, ultrasound NSAIDS Corticosteroid injections Shock wave therapy

12. Treatment Plan Take away source of irritation: boot / crutches, if needed Stretching arch and calf and forefoot Ice Soft tissue massage: gentle to start, advance to aggressive as tolerated Open chain strengthening: manual, bands to both ankle and forefoot

13. Treatment Plan Advance to closed chain strengthening and balance work as symptoms allow Brisk walking, cross training, pain free Add light impact Phase return to run program, watch running form Gradual progressions : 10 % rule Sports specific return to activities

14. THANKS