CONDITIONS anti-inflammatory drugs, night splints, heel cups/pads, injections, cases

CONDITIONS

·        
caused by overuse injury commonly
find in middle aged people

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·        
common cause of heel pain

·        
continuous  traction forces affecting on planter fasica at
origin point over the distal calcaneus may result in to this condition

PRESENTATION

·        
During the physical
examination its important to ask the patient about the things that makes the
pain worse or ease the patient situation.

·        
severe sharp pain history
at 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 & anterior
aspect of caclacaneus near the sole of heel are its characteristics features. In
case 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 and
the toe walking may be preferred by patients.

·        
Initially there is decrease
in  pain as the patient begin to walk but
it may increase as well as the increase of the activity all over the day.

·        
Pain may get stronger during
 barefooted walk on hard surfaces or
climbing the stairs.

·        
When there is less
severity, the pain will be loacalized below the heel bone but in more serve
cases the pain may be reproduced to the proximal of the planter fascia.

·        
Tight Achilles tendon may
add the severty triggering the limited dorsi flexion

·        
Other foot problems like
pes planus, pes cavus or overpronation can be observed.

·        
Windlass Test (Passive
dorsiflexion of toes)

PHYSICAL EXAMINATION:

·           
During the examination,
palpation over the planter medial calcaneal
tubercle at point of planter fascia to heel bone , may reproduce the pain of
planter fasciitis.

·           
According to some
studies, Sometime patients adopt such walking pattern where they can offload
the heel and medial fore foot to compensate and reduce pain

 

 

 

FACTORS WHICH
MAY INCREASE THE RISK OF DEVELOPING THESE CONDITIONS

There are many
proposed 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 metatarsophalangeal
joint (MPJ)

 

ORTHOTIC
INTERVENTIONS

·        
Non surgical treatments
include rest, massage therapy, non-steroidal anti-inflammatory drugs, night
splints, heel cups/pads, injections, cases
and physiotherapy options like sock wave therapy.

·        
Studies shows that 90% of
patients are successfully treated with non surgical management.

·        
If condition remain same
after 6 months of the start of non surgical treatment, surgery is the only
option.

 

·        
First treatment option for planter fascitis is the
orthotic management.

·        
Orthotics management is
low cost, noninvasive and economically more acceptable to the patient.

·        
The purpose of the
orthotic treatment is to adapt the unnecessary mechanical stresses and to prevent the strains due to
overloading on planter fascia.

·        
When we are fabricating
or selecting the orthosis , at that time it is important to see the condition
of the planter arch and the fat pad under the heel. These two factors are
considered to increase the strain,

·        
Foot orthosis is an effective way to provide
the immediate , intermediate or long term relief.

·        
It is very much needed to get the response of
the patients either they we benefited , average or completely not benefited
from either of the options..

·        
Strong evidence is still require to choose
between the prefabricated and customized orthses for such condition to get
effective outcomes.

 

HEEL
CUSHIONS & PADS

Heel pads are usually  made up  of polyvinyl chloride, silicone, leather,
polyethylene foams like Plastizote, and thermoplastics

 

·        
Provision of extra shock absorption in the heel
area

·        
Help to shock absorbing during heel stricke and
running.

·        
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 softer
durometer part. The special design is to dissolve weight around the plantar
medial tubercle of the calcaneus.

·        
A slight heel lift not thicker than one quarter
inch is some time help fot to shift pressure to forefoot.

·        
A heel lift is helpful in shifting pressure to
the forefoot. Keep in mind that

 

THE SOFT INSOLE

·        
with adjusted medial arah
support – reduces the tension through out the fascia.

 

POSTERIOR
NIGHT SPLINT

 

·        
an ankle-foot orthosis (AFO) positioned in
about 5 degrees dorsiflexion.

·        
only to wear at night.

·        
To prevent the contractures of Planter fascia
at night in result of planter flexed position.

 

 

 

 

(A)            
REASONS OF DEVELOPING THE ANKLE EQUINUS DEFROMITY

 

·        
Walking on toes is an indication of equinus deformity.

·        
Foot compensates the
displaced weight over it ans may cause, planter fasciitis,Hallux Limitus,
Tendonitis and metatarsalgia.

·        
The ankle Equinus
Deformity can be due to many different etiologies:

o  
Tightness of the calf muscles ,Gastrocenimius, . When
Tendon  Achillus is more tight then due
to its attachment on the Calcaneus , it pull backs the foot upwards. This
results the patient to put extra weight on the forefoot .

o  
Tightness or contracture
of the soleus muscle

o  
Planter fasciitis – to avoid
the weight on heel

 

(C) FIXED ANKLE EQUINUS
DEFORMITY CAN RESULT INTO GENU RECURVATUM

 

·        
Fixation of ankle in equinus position stops the rotation
casued by the contracture of the

isolated
gastrocnemius. This position brings the ipsilateral knee in a terminal extention
or fully straighten condition. This is caused by the gastrocnemius placements
along the knee, ankle and subtalar joints

·        
In this fixed ankle situation  the dorsiflexion stopped and there is a
unusual tightness in gastrocnemius created at the wrong moment .

·        
Two apposing forces are produced simultaneously by this
knee extension resulting the increase in tension force directly and leveraged
force indirectly at foot and ankle below.

Causing  knee hyperextension in case of the restricted
dorsiflexion.

x

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