Plantar Fasciitis with Associated Calcaneal Bone Spur

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Imagining Presentation Jamie Thomson and Devin Timpson

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Plantar Fasciitis with Associated Calcaneal Spurs:

Plantar Fasciitis with Associated Calcaneal Spurs Jamie Thomson & Devin Timpson February 19 th , 2013

General Description:

General Description What is plantar fasciitis? Inflammation of the plantar fascia (also known as heel spur syndrome or heel pain syndrome). 1 How does it occur? Excessive traction of plantar fascia 1,2 Chronic inflammation 1,2 Over pronation/supination or Pes Planus in weight bearing

Signs and Symptoms:

Signs and Symptoms What are the signs and symptoms ? Medial calcaneal tuberosity pain on palpation 1,3 Pain along medial arch of foot 3 Pain = morning > night Pain with increased activity ( i.e running, long walks, jumping, ascending/descending stairs)

Diagnosis/Prognosis:

Diagnosis/Prognosis How is it diagnosed ? Clinically: Pain with PFT, pain on lengthening, Hx Imaging: MRI and US 3 Bone spur: via Radiographs 3 What is its prognosis ? Good with traditional PT Although, Repeat frequency is high 3

Treatment Options:

Treatment Options NSAIDS, Cortisone injections Functional training Taping, Night Splinting, Shoe Inserts Education Stretching, Pulsed US Casting Surgical Release

T2 Weighted MRI of Plantar Fasciitis:

T2 Weighted MRI of Plantar Fasciitis Image from http://www.ucsm.ca/ Treatment 4

Radiograph of Associated Calcaneal Bone Spur:

Radiograph of Associated Calcaneal Bone Spur Image from http ://sportspodiatryinfo.files.wordpress.com/2010/10/spurs-x2. jpg 5

Biomechanical Impairments6 :

Biomechanical Impairments 6 Tight plantar fascia and gastroc soleus junction (Achilles Tendon ) Increased pain in weight bearing Difficulty with gait related activities Shortened stance time on affected side Decreased toe off d/t stretch of plantar fascia Possibly only a toe walker due to pain at medial calcaneal tuberosity

Role of Imaging:

Role of Imaging How valid are these associations? Kumai and Benajmin 2 suggest vertical compression and surrounding musculature as cause of bone spur  not plantar fascia Often MRI and US not performed Why?  expensive and time consuming

Summary/Key Points :

Summary/Key Points As PT’s we will see Plantar Fasciitis often in the clinic MRI is the best tool to identify plantar fasciitis, but US may be the most cost effective Calcaneal bone spurs are not always associated with plantar fasciitis Future imaging studies need to focus on cause and effect relationship of plantar fasciitis and calcaneal bone spurs

Questions:

Questions When would it be appropriate to order imaging in treatment of a patient with chronic plantar fasciitis? On internship did you treat any patients with plantar fasciitis? If yes, what would you have done different? If no, what interventions would you consider?

References:

References Stuber K, Kristmanson K. Conservative therapy for plantar fasciitis: a narrative review of randomized controlled trials. J Can Chiropr Assoc. 2006 June; 50(2): 118-133. Kumai T, Benjamin M. Heel spur formation and the subcalcaneal enthesis of the plantar fascia. The Journal of Rheumatology. 2002; 29: 1957-1964. McPoil TG, Martin RL, Cornwall MW, et al. Heel p ain –plantar f asciitis: clinical p ractice guidelines linked to i nternational classifications of function, disability, and health from the orthopedic s ection of the american physical therapy a ssociation. J Orthop Sports Phys Ther . 2008:38(4): A1-A18. Canadian Sports Medicine. http://www.ucsm.ca/ Treatment. 2008; Accessed on Feb 17 2013. Griffiths I. Plantar Calcaneal (heel ) Spur. http://sportspodiatryinfo.wordpress.com/2010/10/18/plantar-calcaneal-heel-spurs /. October 2010. Accessed on Feb 17, 2013. Thomas JL, Christensen JC, Kravitz SR, et al. The diagnosis and treatment of heel pain: a clinical practice guideline – revision 2010. The ournal of Foot & Ankle Surgery. 2010: 49; S1-S19.

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