Plantar Fasciitis

[wutti]

sorry have no ideas or experience with the boot/ socks. but maybe you could first try it with taping. had good feedback in the past and its much cheaper!!
cheers

[MrPhysio+]

Hi
I use a progressive plan for treatment of plantar fasciitis.
1. Ensure the diagnosis - often high arches, and the first 3 or 4 steps in the morning or after rest causes severe pain and altered gait. If chronic, other changes occur, eg shortened calf due to walking on the ball of the foot.

2. Provide an explanation to the patient. Describe the condition as shortened irritated structures that progress to a mechanical ongoing irritation. Cortisone will only give short term relief, as the mechanical effect remains unaddresssed.
Surgery is not advised as a solution - eg cutting fibrous tissue to lengthen.
Taping will support the arch for pain relief, as will orthotics, however the problem is eventually worsened unless the other therapy is applied.
3. Describe the treatment as a combination of applied technique by the therapist, plus a specific exercise prfogram that the patient must adhere to.

4. Treat : Apply a stripping high force friction massage along the longitudinal arch from the metatarsophalangeal joint to the midfoot. Use your knuckle, and apply sufficient force to cause the therapist a fair amount of discomfort. The patient should be warned of the severe pain this will cause. Make sure the foot is held down with the other hand, and watch out for reflex kicking by the free leg! Repeat for a total of three times, covering all the plantar fascia.

5. Have the patient walk again. Usually the pain is significantly less, if you have provided enough force.

6. Instruct the patient to obtain a 300 to 600 millilitre size plastic bottle (eg Coke bottle which has a waist and chest shape to fit the foot), empty the contents, fill up with water leaving a little space at the top, cap the bottle, and freeze. Use the frozen bottle uder the affected foot as a rolling pin, in standing with about one third body weight applied. The rolling will massage the fascia, mobilise the mid and forefoot, and the cold will act as analgesia and oedema control as necessary.
Initially the patient may only manage 60 seconds, but can build up tolerance to a few minutes. The numbing effect of the cold allows increased body pressure through the sore structures. A cloth or socks can be used if the bottle is to cold initially, but best without (Avoid excessive cold for those with neurodegenerative diseases or diabetic neuropathy).

7. Continue above treatment twice daily for up to three weeks. Patient can report by phone weekly if required. If the above does not help sufficiently, a resting night splint which provides a sustained stretch for up to 6 hours overnight can help speed the process. A rigid rather than soft arrangement is needed, as the fabric or neoprene splints do not provide enough stretch. The coffin type box which has a wedge under the plantar surface of the foot, with the lower leg strapped in, whilst the toes are extended, is best.

8. Stretch the calf muscles as well if indicated. Stand on step, the foot to be stretched half on and the other fully supported. Bend the contralateral knee, and keep the affected side knee straight. Lower the heel until a stretch is felt in the affected calf, hold at least 15 seconds without bouncing, and repeat 3 times 3-4 times a day. Best to do the stretch after a warm up walk.
Let us know how you get on if the above suggestions are applied.

Patients hate the treatment but love the results - hopefully.
MrPhysio+

[mcasus]

My patients have had very good outcomes using the frozen water bottle, stretching exs as well as exs for the intrinsics. I think it's very important to look at footwear too--did the patient recently start wearing different shoes? Are his/her curent shoes, on the other hand, worn out? Several patients I treated with plantar fasciitis this year had recently started wearing Birkenstock-style sandals (cork soles), and related the start of the problem with the start of wearing those. Problem cleared up with above treatment plan and change of footwear.

[sonka]

Hello.
I have very good results using kinesio-taping.

[alefdlr]

With other colleagues we have had good results using plantar fasciitis taping, we position the ankle, foot and the toes in an elongated position for the plantar fascia.

Before the taping we apply deep myofascial massage. This massage provokes a lot of pain in the patient , but after a few minutes it diminishes .

Also the patient has to perform at his home an auto-massage and the use of the "frozen bottle" as MrPhysio+ suggested before.