Plantar Fasciitis Paradigms

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I know discussions of plantar fasciitis are nothing new around here but I would be interested in learning the members' treatment approaches for the FIRST visit and see where we differ. Here's what I have found to work well:

Patients who don't limp into the room and don't have significant ADL dysfunction are given 1) calf stretches to be done every hour (active NWB stretch,towel stretch,or wall stretch), 2) off the shelf medially posted arch supports, 3) recommendations for an appropriate running shoe.

Those with a constant limp (assuming no tear, or other diagnosis) or ADL dysfunction : I add an NSAID or medrol dose pack if severe enough.

What do you do for intial treatment ?????

Nick

 

Very similar but:

On first visit
a) If interferring with ADL's or sports:
- stretching for calf and plantar tissues
- ice
- activity modification
- low dye strapping

b) If not interferring with ADL's or sports:
- stretching for calf and plantar tissues
- prefabs modified to bring windlass on earlier and lower force to establish it

 

Brilliant

Craig,
We have had excellent success with plantar fasciitis and I have always wondered something. I try to theorize that we are shortening the distance from the origin to the insertion of the plantar fasciae by raising the MLA thus decreasing the stress on the fasciae. The problem is that an agressive MLA supported orthotic will curve the pathway of the PF and put additional stress on the tissues. That seems to contradict. What you wrote clears it up. By increasing the declination angle of the first metatarsal, supinating the foot, you radically decrease the amount of force necessary to establish the windlass effect as an intrinsic supinator.

Thanks,

Ed

 

Calf stretches make sense, but you must be certain that their is a length deficiency in the first place. Compare lunges etc. and make sure that the gastro-soleus is shorter on the affected side.

Like Craig suggested strapping is sensational, diagnostically, and more so therapeutically. It also enables the calf stretch to totally bypass the PF; which may be the goal early acute stage.

As has also been suggested, the acutely tender structures don't want anything pushing into them.

 

modifying prefabs to bring windlass on earlier and lower force to establish it...

Craig or anyone else,

What specific modifications would you make to a Prefab to lower windlass initiation force and for it to initiate earlier??

1st ray cutouts? Reverse mortons extensions? Am i barking up the right tree??

Anything else that i could try?

Phil

 

So far research has shown that:
1) Bring it on earlier (assuming its delayed in the first place)
- heel raise
- preload the hallux (ie sub proximal phalanx padding; eg Cluffy wedge; Kinetic wedge)
- running shoe with higher denisty midsole sub hallux (eg NB2050 ... they have changed the number on that model now)

2) Lower the force to estabilish the windlass (ie reduce forces going thru the structure that is injured):
- wedge the heel (with skive or post - its does not have to actually change calc position, but will still lower windlass establishment forces)
- lateral column support (eg cuboid 'notch')
- elevate lateral metatarsals (eg kinetic wedge; 2-5 bar; forefoot valgus post; met dome)
- plantarflex first ray (eg first ray cut out - very big one; kinetic wedge; 2-5 bar; forefoot valgus post; met dome)
- running shoes with softer material under medial column (eg Nike Structure triax 8)