Plantar Fasciitis: Assessment and Intervention Strategies

Plantar Fasciitis: Assessment and Intervention Stategies

By Bart Satterfield IV, SPT

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Background:

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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.

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Overview/Purpose:

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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 management^2,3. 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.

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Products:

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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.

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Associated Work:

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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 foot^4–6.

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Evaluation:

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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 10^th grade level could understand it. I created an evaluation form that will be handed out at the completion of my powerpoint presentation.

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Self-reflection: 

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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.

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Acknowledgements: 

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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.

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References:

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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.

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