Test your knowledge: plantar fasciitis

Question:

Following on the post of my colleague Saif Usman, this week I am wondering what YOU do in the treatment of  a patient with plantar fasciitis? In the picture below you can see a patient I’ve seen a month ago in my practice. I’ve conducted an ultrasonographic examination on top of the anamnestic and other clinical findings. Please read the text in the image and let me know what you think about treatment options in a patient with long-lasting plantar fasciitis. Hopefully, you can give me an update on the latest evidence on this subject!

In the answer, which will be posted within 8 hours, you can read mean thickness of the plantar fascia in symptomatic and asymptomatic patients in a review table of 12 studies.

(Image by: author)

Answer:

Thank you for your reactions! 

In the table you can see the mean thickness of the normal and symptomatic fascia. Note that a symptomatic and very painful fascia is only 2.0-2.5 mm thicker than normal! So what is only 2.0 mm in a total body length from a dutch man measuring 1860.0 mm?! Nevertheless, there is enough evidence that a plantar fascia that is thicker than 2.0 mm or more can be related to a painful heel! 

Treatment options can be read in our earlier post by Saif Usman, but here are a few of my suggestions:
- Exercise calf raise and excentric loading of the calf;
- Pediatric options for inlay soles to prevent medial weightbearing of the heel;
- Strengthening the kinetic chain preventing kneeing in and medial weightbearing of the heel;
- Medium load of Exctracorporeal Shock Wave Therapy (example: 1.4-1.8 bar 4-10Hz, 2000x);
- Fascia taping in the ‘acute painfull’ period;
- Preventing heel weightbearing through postural instruction (foot midstance load!).

...Custom made solutions in agreement with other specialists, such as podiatrists, general practitioners and orthopaedic surgeons.