PLANTAR FASCIITIS, CALCANEAL SPuR & TENDO ACHILlITIS …

1. PLANTAR FASCIITIS, CALCANEAL SPuR & TENDO ACHILlITIS…

2. Plantar fasciitis

3. Plantar fasciitis is a painful inflammatory process of the plantar fascia

4. Most common cause of foot pain in outpatient medicine Majority of cases occur in patients with no other disease

6. Feet roll inward too much when you walk (excessive pronation) High arches or flat feet Walk, stand, or run for long periods of time, especially on hard surfaces Overweight Wear shoes that don't fit well or are worn out Tight Achilles tendons or calf muscles Causes

7. Extrinsic factors • Training errors • Improper footwear • Unyielding running surfaces • Intrinsic factors • Pesplanus w/ hyperpronation • Pescavus w/ supination • Tight heel cords • Weak intrinsic foot muscles Risk factors

8. 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 Symptoms

9. X-ray MRI diagnosis

11. Calcaneal stress fracture Flexor hallucislongus tendonitis Tarsal tunnel syndrome Fat pad insufficiency Paget’s disease of bone Mid foot DJD Reiter’s syndrome (inflammatory arthritis) Differential DiagnosEs

12. Planta fascia test vs foot intrinsics • Plantar fascitis • Passively DF toes & ankle & palpate medial plantar tubercle of the calcaneus • Foot intrinsics • Curl toes around finger & then resist (+ = pain for both tests) Special Tests

14. Nonsteroidal anti-inflammatory drugs (NSAIDs). • Ibuprofen (advil, motrin) • Naproxen (aleve) • Corticosteroids • Iontophoresis • Injection Medical Management

15. Surgery • Few people need surgery to detach the plantar fascia from the heel bone • Side effects include a weakening of the arch in your foot

16. Modalities • Iontophoresis • Ultrasound • Shoe inserts • Taping • Supportive shoes • Night splints (orthitic) • Stretching program: arch, calf • Soft tissue massage • Ice Pysiotherapy management

19. Calcaneal spur

20. A calcaneal spur is a small bony projection that is formed on the calcaneus or heel bone, either at the back of the heel or under the sole of the heel

21. A sharp, stabbing or dull but intense pain under or on the inside of the heel The pain is typically relieved during rest, but is worse after getting up again As a rule of thumb, it is most painful first thing in the morning The feet or calf muscles may feel very stiff in the morning, making walking difficult Symptoms

22. The pain is made worse by walking on a hard surface or carrying something heavy The pain can become so severe that it becomes difficult to continue your daily work Calcaneal spurs may cause no symptoms at all

23. It's caused by damage to the bone accumulating over a long period of time as a result of chronic inflammation of the Achilles tendon in the calf or the tough sinewy tissues called the plantar fascia, which is found on the soles of the feet Causes

24. People who are overweight and middle-aged Weekend athletes whose muscles aren't tuned up for sudden intense activity People who have feet that are pronated and not corrected Risk factors

25. X-ray diagnosis

26. Heel Tap ("Bump") Test • Patient sitting or lying supine • The involved foot off the end of the table & the knee straight • Examiner stabilizes the lower leg with one hand & bumps the calcaneus with the other hand • Examiner bumps the calcaneus 2–3 times with progressively more force • Positive test pain (at area of complaint) Special tests

27. Avoidance of wearing high heels is recommend in all cases Pain killers Cortisone injection Surgery Medical management

28. Stretching exercises Shoe recommendations Shoe inserts or orthotic devices Taping or strapping to rest stressed muscles and tendons Physiotherapy manegement

31. TENDO ACHILlITIs

32. It is the inflammation of the Achilles tendon The weakest area of the Achilles tendon in adults is found approximately 3 cm above the point of attachment on the heel bone In children and adolescents the weakest area is often at the actual point of attachment on the heel bone Inflammation of the Achilles tendon is therefore relatively rarely seen in children and adolescents

34. Pain when activating the Achilles tendon (running and jumping), when applying pressure and with stretching of the tendon The tendon often feels thickened Symptoms

35. Age Overuse of the tendon Sudden extra exertion, such as a final sprint Calf pain Starting up too quickly, especially after a long period of rest Causes & risk factors

36. X-ray MRI diagnosis

37. Anterior Drawer Test • Steps Athlete is sitting over the edge of the table with the knee bent • Examiner stabilizes the lower leg with one hand & cups the calcaneus with the forearm supporting the foot in slight plantar flexion (~ 20° ) and slight inversion (few degrees) • Examiner draws the calcaneus & talus anteriorly and slighlty medially • Positive test pain, anterior translation, dimple/sulcus, and/or "clunk" Special tests

38. Rest, to allow the inflammation to settle Regular pain relief with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen Steroid injections Surgery (rarely needed) to remove fibrous tissue and repair tears Medical management

39. Stretching Strengthen the weak muscle group in the front of the leg and the upward foot flexors Footwear to be in good condition (good running shoes with shock absorbing heel and close fitting heel cap if an athlete) Pressure on the Achilles tendon can be relieved by using shoes with an elevated heel Physiotherapy manegement

40. If experiencing tenderness in the Achilles tendon during the rehabilitation period, treatment with ice for a period of at least 20 minutes is recommended Bandaging Ultrasound

42. THANK YOU!!!