NORMAL PLANTAR FASCIA THICKNESS IN ADULT

Background: Plantar fasciitis is a common problem caused by thickening of the plantar fascia. The normal plantar fascia thickness ranged between 2-3 mm and it was generally accepted that value more than 4mm was considered pathologic. Objective: to identify normal plantar fascia thickness in adults using ultrasonography. Methods: This is a cross sectional study measuring the thickness of plantar fascia in 145 subjects with no history of heel pain. Plantar fascia thickness was measured in both feet using an ultrasound. Age, height and weight were recorded and analysed. Results: As much as 145 subjects were included in this study. Male to female ratio was 0.7. Mean age was 44 and body mass index (BMI) was mostly within normal range. Plantar fascia thickness in male was 2.71 ± 0.48 mm in right foot, and 2.74 ± 0.47 mm in left foot. Fascia thickness in female was 2.55 ± 0.50 mm in right foot, and 2.57 ± 0.45 mm in left foot. There was a significant plantar fascia thickness difference between male and female (p = 0.035 in right foot, and p=0.04 in left foot). Age, weight and BMI had a significant correlation towards plantar fascia thickness. In multivariate analysis, age and BMI revealed to have a linear correlation to plantar fascia thickness Conclusion: Age and BMI were found to be the best predictive factor of plantar fascia thickness.

Chronic plantar heel pain modifies associations of ankle plantarflexor strength and body mass index with calcaneal bone density and microarchitecture

Chronic plantar heel pain (CPHP) is associated with calcaneal bone spurs, but its associations with other calcaneal bone features are unknown. This study therefore aimed to determine associations between having CPHP and bone density and microarchitecture of the calcaneus. We assessed 220 participants with CPHP and 100 age- and sex-matched population-based controls. Trabecular bone density, thickness, separation and number, BV/TV, and cortical density, thickness and area were measured using a Scanco Xtreme1 HR-pQCT scanner at a plantar and mid-calcaneal site. Clinical, physical activity and disease history data were also collected. Associations with bone outcomes were assessed using multivariable linear regression adjusting for age, sex, physical activity, BMI and ankle plantarflexor strength. We assessed for potential effect modification of CPHP on these covariates using interaction terms. There were univariable associations at the plantar calcaneus where higher trabecular bone density, BV/TV and thickness and lower trabecular separation were associated with CPHP. In multivariable models, having CPHP was not independently associated with any bone outcome, but modified associations of BMI and ankle plantarflexor strength with mid-calcaneal and plantar bone outcomes respectively. Beneficial associations of BMI with mid-calcaneal trabecular density (BMI-case interaction standardised X/unstandardised Y beta -10.8(mgHA/cm3) (se 4.6), thickness -0.002(mm) (se 0.001) and BV/TV -0.009(%) (se 0.004) were reduced in people with CPHP. Beneficial associations of ankle plantarflexor strength with plantar trabecular density (ankle plantarflexor strength -case interaction -11.9(mgHA/cm3) (se 4.4)), thickness -0.003(mm) (se 0.001), separation -0.003(mm) (se 0.001) and BV/TV -0.010(%) (se 0.004) were also reduced. CPHP may have consequences for calcaneal bone density and microarchitecture by modifying associations of BMI and ankle plantarflexor strength with calcaneal bone outcomes. The reasons for these case-control differences are uncertain but could include a bone response to entheseal stress, altered loading habits and/or pain mechanisms. Confirmation with longitudinal study is required.

Symptomatic Intraosseous Lipoma of the Calcaneum

Intraosseous lipomas are rare bone lesions that can affect any part of the skeleton. In the calcaneum, they are, generally, asymptomatic, but in some cases, patients may complain of pain, swelling or tenderness. Well-conducted radiography and MRI examinations can lead to an accurate diagnosis. In most cases, patients could benefit from conservative means of treatment, but in long-lasting symptomatic cases, surgical treatment may be a good option. The purpose of this article is to increase clinicians’ awareness of this lesion as a possible cause of heel pain and to describe a case of a symptomatic intraosseous lipoma of the calcaneum who underwent curettage and bone cement filling after failure of conservative treatment.

Plantar fasciopathy—looking beyond the obvious? A case report

Background The biggest challenge in treating this diagnosis is the lack of literature focusing on regional interdependence. The current literature suggests a narrow and localized approach targeting plantar fascia and ankle/foot complex. The literature available on conservative treatment focused on utilizing various inflammatory modalities such as injections and extracorporeal shockwave therapy. The surgical approach targets Baxter’s nerve decompression techniques and releases techniques to the gastrocnemius and plantar fascia. The article focuses on utilizing manual therapy techniques to the lumbosacral spine and plantar fascia. In addition, the neurodynamic flossing targeted lateral plantar nerve mobility. Case presentation The patient is a 54-year-old African American female seen for right heel pain at Texas’s outpatient orthopedic physical therapy clinic. The patient had the diagnosis of plantar fasciopathy with negative Windlass testing. The patient was provided manual therapy interventions to the lumbosacral spine and plantar fascia to improve weight-bearing patterns and overall functional outcomes. Conclusion The manual therapy interventions to the lumbosacral spine and plantar fascia and flossing techniques to the lateral plantar nerve improved symptoms of heel pain. The patient showed improved outcomes with this approach.

Ultrasonography features of the intrinsic foot muscles in patients with and without plantar fasciitis: A novel case-control research study

IntroductionPlantar fasciitis (PF) is the most common cause of heel pain.(1) This condition was described as a degenerative syndrome associated with pain, lack of functionality and stiffness on the plantar fascia. The aim of the present study was to compare with ultrasound imaging (USI) the thickness and cross-sectional area of the intrinsic foot muscles between individuals with and without plantar fasciitis (PF).Material and methodsA total of 64 volunteers from 18 to 55 years were recruited for the present study. The sample was divided in two groups: A group, composed of participants diagnosed by PF (n = 32) and B group, composed by healthy participants (n = 32).ResultsUSI measurements for FBH CSA (p = 0.035) was decreasing showing statistically significant differences for the PF group, while the QP CSA (p = 0.40) was increasing reporting statistically significant differences for the PF group with respect the healthy group. The rest of the IFM did not show statistically significant differences, however in FHB, FDB, QP and AHB thicknesses and FDB CSA a slightly decrease for the PF group have been observed.ConclusionsUSI measurements showed that the CSA of the FHB muscle is reduced in patients with PF while the CSA of the QP muscle is increased in patients with PF.

Efficacy of Instrument Assisted Soft-Tissue Mobilization in Patients with Heel Pain: An Experimental Study

Aim: The purpose of this study was to evaluate and compare the effects of Instrument-Assisted Soft-Tissue Mobilisation (IASTM) and Therapeutic Ultrasound in patients with heel pain in terms of Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale. This was undertaken as even though Ultrasound is regularly used, heel pain still remains resistant to treatment in some patients. Hence, the need to compare a relatively newer technique with it. Study Design : Experimental study Place and Duration: Department of Musculoskeletal Physiotherapy Sciences, Ravi Nair Physiotherapy College, Sawangi (Meghe) , Wardha , duration of 12 months. Methods: Seventy people (n=70) with heel discomfort (lasting 6 weeks to 1 year) were chosen at random and placed into two groups, each getting eight therapy sessions. IASTM and Home Exercise Program was given to Group A, whereas Therapeutic Ultrasound and Home Exercise Program was given to Group Calf muscle stretches and Plantar fascia stretches were incorporated in the Home Exercise Programme. Outcome measures were recorded both at the beginning of treatment and after final treatment. The patients were assessed for Numerical Pain Rating Scale with first step in morning and at the beginning of first session and after end of last session and for Foot and Ankle Ability Measure scale at the beginning of first session and after end of last session. A follow up period of 90 days (after last session) was taken, the measurements of Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale were taken again to see the long-term effects. Results: Group A which received IASTM + Home exercises showed great improvements than Ultrasound and Home exercise group, from baseline to week 4 after the pain intensity and foot function were assessed using Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale. Statistically significant differences were found in both the groups. i.e. P=0.0001. But 7 people in Ultrasound group complained of pain and functional ability at follow-up session. Conclusion: In this study, it can be concluded that combining both the IASTM and Home Exercise Program have got beneficial effects in decreasing the pain intensity thus improving the foot and ankle function in patients with heel pain.