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Plantar Fasciitis: Assessment and Intervention Stategies

By Bart Satterfield IV, SPT


Background:


My interest in foot and ankle pathologies began after the foot and ankle section of our Musculoskeletal II course that was taught by Dr. Michael Gross, PT, PhD, FAPTA, who specializes in the fabrication of custom orthotics. During my second clinical rotation, I had the opportunity to work with a couple patients with foot and ankle pathologies and with each encounter my desire to learn more grew. One patient in particular was dealing with plantar fasciitis for ~5 months and was growing frustrated because she was not making progress with standard care. She asked me about other potential treatment options but, unfortunately, I was not able to provide an adequate answer. This situation led me on a pursuit for the answer, which ignited the idea for this capstone project. Since that time, my passion for evaluating and treating foot and ankle pathologies continued to grow as I worked specifically with this population with Dr. Gross in the clinic.


Overview/Purpose:


Planter fasciitis is commonly treated by physical therapists and can be burdensome for the individuals dealing with it. This condition is one of the most common foot conditions and occurs in approximately 2 million individuals every year1. Symptoms associated with plantar fasciitis typically resolve between 6 to 18 months for 80% of individuals but 5% of them require surgical intervention due to failing conservative management2,3. From my literature review, some of the commonly used interventions do not provide clinically significant results. There are also some modalities and non-physical therapy interventions that clinicians may not be knowledgeable of. Although clinicians may not perform these interventions, our patients are likely to inquire about them so we should be familiar with their outcomes in order to answer these questions. This capstone reviews the mechanical behavior, risk factors, and physical therapy and non-physical therapy intervention strategies with supporting evidence. It also provides information in regards to performing an efficient patient evaluation for patients with plantar fasciitis.


Products:


A Quick Reference Guide for clinicians was developed to detail clinical considerations, contributing factors, assessment strategies, and intervention strategies. An evidence table was produced to provide information regarding the effectiveness of specific therapeutic interventions, modalities, and surgical interventions. A patient brochure was made to provide general information regarding plantar fasciitis. I also created a PowerPoint presentation that discusses the assessment and intervention strategies to effectively treat plantar fasciitis. I will present this PowerPoint to the clinicians at the UNC Wellness Center at Meadowmont during my final clinical rotation.


Associated Work:


During our EPB II course, I developed a Critically Appraised Topic (CAT) that determined if platelet rich plasma or corticosteroids injections provided better short/long term pain relief for individuals with chronic (>3 months) plantar fasciitis. This CAT provided evidence supporting minimally invasive procedures that could be used to avoid the plantar fascia release procedures, which negatively influence the biomechanics of the foot4–6.


Evaluation:


During this process, I maintained contact with my capstone committee and received valuable feedback on each component of my capstone project. For my patient handout, I reviewed the health literacy information to ensure individuals that read on a 10th grade level could understand it. I created an evaluation form that will be handed out at the completion of my powerpoint presentation.


Self-reflection: 


Along with our EPB II course, this process reinforced the need to analyze evidence instead of simply taking the information at face value. Initially, this process intimidated me but now I am more comfortable with it. Throughout the process of developing this capstone project and working in the clinic with Dr. Gross, I have learned a great deal of information regarding the foot and ankle in general. I look forward to continuing this pursuit of knowledge and using this experience to produce more educational materials for clinicians and patients in the future. I am satisfied with the components of this capstone and I am confident that clinicians, physical therapy students, and patients will find this information beneficial.


Acknowledgements: 


I want to thank Dr. Michael Gross, Dr. van der Horst, and Dr. White for agreeing to be a part of my capstone committee. I appreciate all of the input you all provided during this process.

My capstone advisor, Michael Gross, PT, PhD, FAPTA, “Jordan of Orthotics”- You ignited my interest in foot/ankle pathologies and allowed me to work under your tutelage in the clinic. You motivated me to consistently search beyond the basic knowledge in order to provide the best possible patient care.

Sarah van der Horst, PT, DPT, OCS- You are a phenomenal role model. You strive to pursue clinical excellence while also donating time to those that are less fortunate. Due to our course load, I often told myself I “did not have the time” for outside commitments but seeing your work in the community, particularly your work founding and directing the Amigas en Salud program, is inspiring.

Michael White, PT, DPT- Thank you for all of the time you spent in efforts to make me the best clinician possible. Before I met you I was hesitant and lacked confidence in my clinical decision making skills. You gave me the freedom to make mistakes, which facilitated my growth as a clinician. I cannot thank you enough for that.

Lastly, I have to thank Casey Kalb, PT, DPT, OCS and Jackson Ballard, PT, DPT, OCS for opening their doors and allowing me to shadow them while I was in high school. They helped build the foundation for what I have accomplished so far.


References:


  1. Martin RL, Davenport TE, Reischl SF, et al. Heel pain-plantar fasciitis: revision 2014. J Orthop Sports Phys Ther 2014;44(11):A1-33. doi:10.2519/jospt.2014.0303.
  2. Fallano J, Lawon K. Standard of Care: Plantar Fasciitis. BRIGHAM AND WOMEN’S HOSPITAL.
  3. Medscape. Plantar Fasciitis: Background, Anatomy, Pathophysiology. Available at: https://emedicine.medscape.com/article/86143-overview#a7. Accessed February 27, 2018.
  4. Sharkey NA, Donahue SW, Ferris L. Biomechanical consequences of plantar fascial release or rupture during gait. Part II: alterations in forefoot loading. Foot Ankle Int 1999;20(2):86-96. doi:10.1177/107110079902000204.
  5. Huang C-K, Kitaoka HB, An K-N, Chao EYS. Biomechanical evaluation of longitudinal arch stability. Foot Ankle 1993;14(6):353-357. doi:10.1177/107110079301400609.
  6. Kitaoka HB, Luo ZP, An KN. Mechanical behavior of the foot and ankle after plantar fascia release in the unstable foot. Foot Ankle Int 1997;18(1):8-15. doi:10.1177/107110079701800103.

Image retrieved from: https://www.painscience.com/imgs/pf-main-banner-xl.jpg

5 Responses to “Plantar Fasciitis: Assessment and Intervention Strategies”

  1. Elinor Rubin

    Hi Bart,
    This was such a pleasure to read. All of your project products have such tremendous clinical value. In particular, the Quick Reference Guide is a fantastic resource and I plan on using in the clinic with patients. I especially appreciated your inclusion of differential diagnoses and risk factors. Having these key details so clearly outlined in such a well-organized format provides great clinical value in terms of both quality and efficiency.
    The wealth of information in your evidence table is very impressive, and I feel confident I would be able to answer a patient’s questions about treatment options. Having the studies organized by intervention is also going to make it very easy for me to reference responding to individual questions. I also appreciate how you listed the limitations of individual study results. One suggestion might also be to include an assessment of methodological quality, like an AMSTAR or PEDro scale score.
    Good luck with your presentation—although I know you are going to crush it, as usual!

    Reply
  2. Bart Satterfield

    K Mac,
    No problem! Thank you for your input and your swift responses when I had questions!

    Reply
  3. Bart Satterfield

    Hello Jennell,
    Thank you for the feedback and for looking over my patient brochure while I was creating it! Tenex is a relatively new procedure that is performed by making a small incision and inserting a hollow probe, which uses ultrasonic energy to break up and remove scar tissue1. It is minimally invasive so there are no stitches and patients usually return back to full physical activity in 6-8 weeks1. I was unaware of this procedure until Dr. Gross told me about it during my ICE. Currently, there is not a large body of evidence to support it but Dr. Gross works with a physician who gets good results from it. It may be a better alternative to more invasive procedures.

    1–TenexHealth. FAQ . Tenex Health. https://tenexhealth.com/faq/. Accessed April 22, 2018.

    Reply
  4. K-Mac

    Nice work on this Bart!!! Impressive that you were the first to post as well – thanks for helping clarify the issues that other students needed to know about posting larger files.
    See you soon at the airport!!! 🙂
    kmac

    Reply
  5. Jennell Mcintosh

    Bart, I really enjoyed learning more about Plantar Fasciitis from your capstone project! I too saw a few patients with Plantar Fasciitis during my first clinical affiliation and could’ve benefited greatly from your capstone products to better treat them. I was surprised to learn that ultrasound has no therapeutic benefit as this was the go to treatment during my first clinical. You make a good point about it being important for PTs to be knowledgeable about non-PT interventions because our patients will indeed ask about them. I really liked how you organized your evidence table based on the different interventions and your brochure paid great attention to the health literacy of patients. Your powerpoint was very informative as well. I’ve never heard of some of the non-PT interventions and I’m still not quite sure what Tenex is from the picture. I’m sure you’ll do a great job explaining it during your presentation in your last clinical. The pictures and comics added some extra entertainment to your powerpoint as well and some of them made me laugh. Great job Bart!

    Reply

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