Definition of Plantar Fasciitis:
- inflammation of the plantar fascial or perifascial bursae
- most commonly involves the origin of the plantar fascia on the medial tubercle of the calcaneus
- may progress to thickening of the plantar fascia or traction spurring of the calcaneus
Etiological/Biomechanical Factors
- improper or worn out footwear
- abnormal biomechanics in the lower quadrant
- excessive pronation of the subtalar joint and the joint fails to resupinate at toe-off results in increased strain on the plantar fascia
- pes cavus/external tibial torsion, lack of pronation results in an inability of dissipate the forces from heel strike to midstance placing excessive loading on the plantar fascia
Differential Diagnosis
- Systemic : Rheumatoid Arthritis, Ankylosing Spondolysis, Gout
- Metabolic : Osteoporosis
- Degenerative : oseoarthritis, atrophy of the heel pad
- Neurogenic : tarsal tunnel syndrome, medial calcaneal nerve entrapment
- Calcaneal fractures
Physical Findings
- Tenderness at the medial tubercle of the calcaneus and along the length of the plantar fascia
- Pain on passive dorsiflexion of the great toe
- Pain on bowstring the plantarfascia with the great toe held in dorsiflexion
- Poor architecture or biomechanics of the lower quadrant
- Poor foot intrinsic muscle function
Treatment
- Activity modification
- Passive support with taping
- Mobilization to address biomechanics faults
- Education of proper foot wear
- Intrinsic muscle strengthening
Reference1. Level 2 Lower Manual. Orthopaedic Division, Canadian Physiotherapy Association
Taping and Supporting for Plantar Fasciitis
Taping plantar fasciitis can be frustrating at times due to constant irritation of the tissue from weight bearing activities. As outlined earlier, the plantar fascia becomes inflammed due to excess pronation causing a constant stretch and stress on the tissue.
To allow the tissue to heal the plantar fascia must be supported. The most economical and effective way to accomplish over the short term is by taping. Remember to use proper taping principles and to position the foot in a neutral position before taping. The direction of pull is important to maintain a neutral foot position and to prevent over pronation.