CONDITIONS· caused by overuse injury commonlyfind in middle aged people· common cause of heel pain· Develops as an result of continuous traction forces affecting on planterfasica at origin point over the distal calcaneusPRESENTATION· During the physicalexamination its important to ask the patient about the things that makes thepain worse or ease the patient situation. · History of severe sharppain early in the morning at heel during the first couple of steps or after long non weight bearing intervals. · Pain & tenderness ,mostly on the medial & anterioraspect of caclacneus near the sole of heel are its characteristics features. Incase of severity this pain may radiate proximally. · Along with the pain,there may be an issue of localized heel swelling and foot stiffness.· Limping is obvious andthe toe walking may be preferred by patients.· Initially there is decreasein pain as the patient begin to walk butit may increase as well as the increase of the activity all over the day. · Pain may get stronger during barefooted walk on hard surfaces orclimbing the stairs.
· When there is lessseverity, the pain will be loacalized below the heel bone but in more servecases the pain may be reproduced to the proximal of the planter fascia.· Tight Achilles tendon mayadd the severty triggering the limited dorsi flexion· Other foot problems likepes planus, pes cavus or overpronation can be observed.· Windlass Test (Passivedorsiflexion of toes) PHYSICAL EXAMINATION:· During the examination,palpation over the planter medial calcanealtubercle at point of planter fascia to heel bone , may reproduce the pain ofplanter fasciitis.· According to somestudies, Sometime patients adopt such walking pattern where they can offloadthe heel and medial fore foot to compensate and reduce pain FACTORS WHICHMAY INCREASE THE RISK OF DEVELOPING THESE CONDITIONSThere are manyproposed risk factors for plantar heel pain, including· increased body mass index (BMI), · limited ankle joint dorsiflexion, · calcaneal spur, · leg length discrepancy, · diminished thickness of heel pad, · pes planus, · pes cavus, · excess pronation and · limited range of motion of the first metatarsophalangealjoint (MPJ) ORTHOTICINTERVENTIONS· Non surgical treatmentsinclude rest, massage therapy, non-steroidal anti-inflammatory drugs, nightsplints, heel cups/pads, injections, casesand physiotherapy options like sock wave therapy. · Studies shows that 90% ofpatients are successfully treated with non surgical management.
· If condition remain sameafter 6 months of the start of non surgical treatment, surgery is the onlyoption. · First treatment option for planter fascitis is theorthotic management. · Orthotics management islow cost, noninvasive and economically more acceptable to the patient.· The purpose of theorthotic treatment is to adapt the unnecessary mechanical stresses and to prevent the strains due tooverloading on planter fascia. · When we are fabricatingor selecting the orthosis , at that time it is important to see the conditionof the planter arch and the fat pad under the heel. These two factors areconsidered to increase the strain, · Foot orthosis is an effective way to providethe immediate , intermediate or long term relief.
· It is very much needed to get the response ofthe patients either they we benefited , average or completely not benefitedfrom either of the options..· Strong evidence is still require to choosebetween the prefabricated and customized orthses for such condition to geteffective outcomes. HEELCUSHIONS & PADSHeel pads are usually made up of polyvinyl chloride, silicone, leather,polyethylene foams like Plastizote, and thermoplastics · Provision of extra shock absorption in the heelarea· Help to shock absorbing during heel stricke andrunning. · Soft heel cups cushion containing the fat pad,are effective for a plantar calcaneal bursitis or plantar heel spur syndrome· Heel cushion made up of silicon has a built-in softerdurometer part. The special design is to dissolve weight around the plantarmedial tubercle of the calcaneus.
· A slight heel lift not thicker than one quarterinch is some time help fot to shift pressure to forefoot.· A heel lift is helpful in shifting pressure tothe forefoot. Keep in mind that THE SOFT INSOLE · with adjusted medial arahsupport – reduces the tension through out the fascia. POSTERIORNIGHT SPLINT · an ankle-foot orthosis (AFO) positioned inabout 5 degrees dorsiflexion.
· only to wear at night. · To prevent the contractures of Planter fasciaat night in result of planter flexed position.