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