Protocol: Plantar Fasciitis

This describes the various treatment procedures the physical therapist may select, as indicated by patient evaluation, re-evaluation, treatment responses.

Note: This problem often involves a variety of contributory stresses from throughout the lower extremity, particularly from the tarsal tunnel. Some PF problems may actually be TTS,

ACUTE INTERVENTION:

1. Pain control modalities…

Electric stimulation, ice-heat, ultrasound

2. Anti-inflammatory modalities:

Iontophoresis; phonophoresis, LLLT

3. A.M. plantar fascia stretching upon arising before any weightbearing

4. Assess-treat potential Tarsal Tunnel Syndrome

SUBACUTE RECOVERY:

1. Soft or firm corrective orthotic shoe inserts or viscoelastic posted heel cups; to correct pronation and other dysfunctions, to provide cushioning.

2. Night splint to stretch calf; AM plantar fascia stretching before weight-bearing

3. Plantar fascia and calf stretching

4. Transverse Friction Massage

5. Articular and soft tissue manual therapy: strain-counterstrain; myofascial release

6. Ultrasound, iontophoresis, phonophoresis, LLLT

7. Foot intrinsic strengthening exercises

8. Ankle balance board exercises; BAPS closed chain exercises; pliometrics

9. Correct lower quarter imbalances in flexibility-strength

10. Footwear counseling

11. Work site evaluation and advice; job coaching; employer education

GOALS:

Restore work ability and ADL tolerances

Pain control; pain relief

Reduce abnormal mechanical stresses at foot; correct pronation

Restore calf flexibility and foot-ankle dynamic muscle controls

Reduce inflammation

Control scar modeling

Prevent recurrences