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Plantar Fasciitis help
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Plantar Fasciitis help - February 1, 2008 6:25:43 PM
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Kaden
Posts: 335
Joined: June 17, 2007
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40 year old male with 5 month history of plantar fasciitis that I have been treating for 2.5 weeks. Have used US, DTFM, fascial release, stretching, etc.
He is in a superfeet orthotic and we just tried some additional support with low dye taping today.
My difficutly is that he is a janitor and on his feet 8-10 hours a night and by this time his foot is significantly flared. Any advice on products that could help temporarily relieve his pain while at work.
What have others had luck with on a temporary basis - heel cups, bracing, etc.
Any suggestions would be helpful. Any response he has to therapy seems to be erased once he goes to work. I think if we can get him through one to two weeks of decreased pain at work he would do much better.
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RE: Plantar Fasciitis help - February 1, 2008 7:52:27 PM
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PTupdate.com
Posts: 1478
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Lift his heels up, to basically simulate a womans high heel shoe. Do this internally via gel heel cups stacked up (thus you get some cushioning as well), or externally via a good shoe repair guy that can split the heel of his shoe/boot and stuff in a wedge. Also, arch bands to simulate the arch taping technique ($9 in most Rite Aid stores), and ice to the heel when he gets home each night. Tough cases that have to go to work each day and agitate their condition. And, remember to perform a good neuro screen to ensure there is no neural entrapment in the heel, either as the cause of their pain origianlly, or as a secondary problem due to the insertion inflammation and fibrosis.
And, someone just informed me that the pic of me to the left was "creeping her out", so when I get back to town, will change back to happy old Jerry Garcia
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: Plantar Fasciitis help - February 1, 2008 7:55:33 PM
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TexasOrtho
Posts: 560
Joined: December 22, 2007
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The picture freaks me out as well, but I've got a strong stomach.
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Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Plantar Fasciitis help - February 1, 2008 8:15:11 PM
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jma
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Joined: August 24, 2000
From: NY
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Having them use night splints at night on a consistant basis does offer some relief as well, in addition to wearing and breaking in good orthotics.
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RE: Plantar Fasciitis help - February 1, 2008 10:00:21 PM
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allenbr4
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How about a Strassburg sock as an alternative to night splinting? Any opinions?
Sleeping with the feet outside of the sheets, or at least with the sheets untucked at the bottom of the bed, seems like a good idea to avoid prolonged plantar flexion.
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RE: Plantar Fasciitis help - February 2, 2008 7:34:08 AM
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jlharris
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From: Nebraska
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How are his supinators, especially his post tib? Although I should do a better neuro screen, I try to address ROM, structural positioning and muscular support for the arch for longer term results. And, increasing supinator strenght (or, better, improving pronation control) seems to do that for me.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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RE: Plantar Fasciitis help - February 3, 2008 9:51:24 AM
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PainFree
Posts: 84
Joined: August 13, 2006
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Check out Shacklock's website for a recent clinical pearl on heel pain.
Have you worked out the fascia further up the kinetic chain?
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RE: Plantar Fasciitis help - February 4, 2008 3:55:52 AM
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Kaden
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Joined: June 17, 2007
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Thanks for the advice.
Does anyone have a good diagram of low dye taping they can post or send me. It has been a while since I have taped and there are so many techniques for this particular tape job.
What works best for those out there.
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RE: Plantar Fasciitis help - February 4, 2008 3:57:10 PM
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TMondale
Posts: 131
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From: Newton-Wellelsley Hospital
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Kaden,
Picking up from the ortho. side. The way I prefer to low dye is with the person prone and their feet off the end of the table, put a single layer of tape down (1.5 inch) around the plantar met heads, that doesn't connect on the dorsum of the foot. simply take a 1/2 or 3/4 inch strip of athletic tape and begin at iether the 5th or 1st met head. Go from met head to met head; in other words go from the 1st around heel, and back around to the first, 2nd around the heel to 2nd, 3rd around the heel to 3rd, and so on. Put a top coat of 1.5 inch at met heads to tie them all together. Be sure to just lay the tape around the heel without tension, as tension there is often uncomfortable. It's quite easy, and you're right there seems to be many ways that this is done. Have the patient put their socks, and lace up shoes on before they put body weight on the foot. If they aren't getting any reaction to the tape or blistering they can wear for 2-3 days. This has been very helpful for me in the short run, in many cases. Patients can be instructed to tape themselves as well. Maybe I'll put something up on youtube for the way I do it.
Tim
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RE: Plantar Fasciitis help - February 4, 2008 5:35:19 PM
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buckeye
Posts: 175
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Tough case -
What is a superfeet orthotic - custom made, off the shelf, rear foot post, etc?
Not sure what else to offer for relief during the day, especially if quick results are expected. The posts offer some good advice.
Have him work on deceleration control/strength/endurance in the evening after his pain settles somewhat - maybe move more in frontal plane for exercises since this may be more comfortable.
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RE: Plantar Fasciitis help - February 5, 2008 4:20:26 AM
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goodlooks58
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From: CA
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From personal experience of 1 year of pain and suffering, frequent ice packs, taping, elevation and rest is the only help. Stretching can sometimes aggravate symptoms. Strengthening the dorsiflexors and supinators will also help.
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RE: Plantar Fasciitis help - February 7, 2008 10:32:26 AM
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TMondale
Posts: 131
Joined: January 3, 2005
From: Newton-Wellelsley Hospital
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Kaden,
If you're interested we put a little video on google video that shows one way to strap the plantar aspect of the foot. It's quick and easy, and again patients can be shown how to do it for themselves if helpful. I don't know what happened to the audio, but I think it is clear enough. Look under tim mondale plantar foot strapping.
Tim
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RE: Plantar Fasciitis help - February 7, 2008 1:44:34 PM
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Kaden
Posts: 335
Joined: June 17, 2007
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Thanks Tim I will check it out
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