“ “ What Do We Know (or What Do We Know (or not know) about not know) about Plantar Fasciitis? Plantar Fasciitis? Scott T. Doberstein, MS, ATC, LAT Head Athletic Trainer/Senior Lecturer University of Wisconsin – La Crosse Wisconsin Athletic Trainers’ Association Annual Meeting & Symposium Wisconsin Dells, WI April 12, 2013
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“What Do We Know (or not know) about Plantar Fasciitis? Scott T. Doberstein, MS, ATC, LAT Head Athletic Trainer/Senior Lecturer University of Wisconsin.
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““What Do We Know (or not What Do We Know (or not know) about Plantar know) about Plantar
Fasciitis?Fasciitis?
Scott T. Doberstein, MS, ATC, LAT
Head Athletic Trainer/Senior Lecturer
University of Wisconsin – La Crosse
Wisconsin Athletic Trainers’ Association
Annual Meeting & Symposium
Wisconsin Dells, WI
April 12, 2013
THE FOLLOWING PRESENTATION HAS BEEN APPROVED FORTHE FOLLOWING PRESENTATION HAS BEEN APPROVED FOR
[PROFESSIONAL AUDIENCES][PROFESSIONAL AUDIENCES]By the Wisconsin Athletic Trainers’ AssociationBy the Wisconsin Athletic Trainers’ Association
THIS PRESENTATION HAS NOT YET BEEN RATED THIS PRESENTATION HAS NOT YET BEEN RATED
THE FOLLOWING PRESENTATION HAS BEEN APPROVED FORTHE FOLLOWING PRESENTATION HAS BEEN APPROVED FOR
[PROFESSIONAL AUDIENCES][PROFESSIONAL AUDIENCES]By the Wisconsin Athletic Trainers’ AssociationBy the Wisconsin Athletic Trainers’ Association
THIS PRESENTATION HAS NOT YET BEEN RATED THIS PRESENTATION HAS NOT YET BEEN RATED
PF most common cause of heel painPF most common cause of heel pain• 2 million pts seek Tx annually in US 2 million pts seek Tx annually in US (Riddle, (Riddle,
2003)2003)
• PF accounts for 11-15% of all foot S/S PF accounts for 11-15% of all foot S/S seeking professional care seeking professional care (Buchbinder, 2004)(Buchbinder, 2004)
• 10% of running related injuries 10% of running related injuries ((Buchbinder, 2004)Buchbinder, 2004)
PF most common condition Tx by podiatric PF most common condition Tx by podiatric foot/ankle specialists foot/ankle specialists (APMA, 2001)(APMA, 2001)
1812 – Wood first to describe PF as 1812 – Wood first to describe PF as infection secondary to TB infection secondary to TB (Neufeld, 2008)(Neufeld, 2008)
Fascial layer – not a tendon but…Fascial layer – not a tendon but…
Interesting tissue to treat!!Interesting tissue to treat!!
Anatomy/PathophysiologyActually continuous with the Achilles Actually continuous with the Achilles
tendontendon Is it inflammation? Only acutely??Is it inflammation? Only acutely??Most of what we deal with is actually Most of what we deal with is actually
• Resection of PF shows histological evidence Resection of PF shows histological evidence of PLANTAR FASCIOSIS not fasciitis!of PLANTAR FASCIOSIS not fasciitis!
• Collagen necrosis and loss of collagen continuityCollagen necrosis and loss of collagen continuity• Increased ground substanceIncreased ground substance• Increased vascularityIncreased vascularity• Increased fibroblastsIncreased fibroblasts• No inflammation markers or cells (similar to No inflammation markers or cells (similar to
tendinosis) tendinosis)
Caused by repetitive microtears of PF that Caused by repetitive microtears of PF that overtake the body’s ability to repair itselfovertake the body’s ability to repair itself
Heel Spur – significant evidence that bony Heel Spur – significant evidence that bony exostosis does not cause PFexostosis does not cause PF• However, quite common to have an exostosis However, quite common to have an exostosis
simultaneously with PF but…the spur is NOT simultaneously with PF but…the spur is NOT the cause of PFthe cause of PF
Classic Presentation Classic Presentation (What it is!)(What it is!)
Inferior heel pain (self limiting!)Inferior heel pain (self limiting!) Increased pain w/ first steps in morning =Increased pain w/ first steps in morning =
Post Static DyskinesiaPost Static Dyskinesia (McNally, 2010)(McNally, 2010)
Increased pain upon standing after Increased pain upon standing after prolonged sittingprolonged sitting
Increased pain during prolonged standingIncreased pain during prolonged standing Increased pain with barefoot walkingIncreased pain with barefoot walkingPain worsens near end of the dayPain worsens near end of the day
Rest/modification of activityRest/modification of activity IceIceHeatHeatUltrasoundUltrasoundE-stimE-stim IontophoresisIontophoresisStrengthening Strengthening
Orthoses (custom and off the shelf)Orthoses (custom and off the shelf) Injections (corticosteroids, PRP, botulinum Injections (corticosteroids, PRP, botulinum
Extracorporeal Shock Wave Therapy CAutologous Platelet Rich Plasma CIt’s the SHOES (ADL’s vs. activity) E,FNutritional Considerations (Roxas, 2005) E, F
Where art meets science…….??Where art meets science…….??
““No evidence strongly supports the No evidence strongly supports the effectiveness of any treatment of PF, effectiveness of any treatment of PF, and most patients improve without and most patients improve without specific therapy or by using specific therapy or by using conservative measures.” conservative measures.” (Cole, 2005)(Cole, 2005)
Intervention Algorithms?x4
Young, 20011. Correct training errors, relative rest, ice post
activity, inspect footwear 2. Correct biomechanical factors with stretching
and strengthening3. Night splints and orthotics4. All other Tx options considered NSAID’s used throughout Tx but… pt
educated that meds are used for pain control and not curative!
80% of pts have favorable results w/in 12 80% of pts have favorable results w/in 12 months months (Rompe, 2009)(Rompe, 2009)
Further Research
We need more research on many We need more research on many interventions to get a better handle on this interventions to get a better handle on this significant problem!!!significant problem!!!
On the horizon…..??On the horizon…..??• Injections of botulinum toxin• Injections of autologous platelet rich plasma• Anything else you can think of??????