What are we listening to lately?
We have been getting into David Pope and the “Physioedge” podcast.
This particular title piqued our interest talking all about plantar fasial pain. It is an interview with Michael Rathleff from Denmark. Michael works in the areas of patellofemoral research, plantar fascia research, and exercise.
Approximately 10% of the population from 840 to 60 suffers from some sort of plantar fasciopathy. These people usually have jobs where they are upright and standing on her feet for extended periods of time.
Plantar fascial pain seems to respond better to loading-based therapies rather than stretching-based therapies, due to the similarities between tendons and fascia . He emphasizes not to overlook educating the patient about their condition and taking the time to explain what’s going on. He then goes on to talk about activity modification in the treatment plan.
He classifies two major types of people who develop planter for shop: runners and people that are overweight ( repetitive loading versus constant loading).
Pain patterning is often threefold:
1. pain during the workday
2. pain when they get home
3. pain after they get up after taking a rest for any length of time.
So, how much can you reduce the loading and, how much does that reduce their symptoms? With runners it’s a little easier as you can just tell them to reduce their mileage.
Some “rules of engagement” are given: runners need to be able to walk a 10K briskly, without pain before during or after or at three time frames when they had pain before. After this baby can begin a running program eight weeks of five k’s of continued running. Ching that yes this can take some time is important and offering the patient alternative means of exercise (cycling, swimming etc.) is important.
Running should begin with one minute running, two minute walking and repeating the cycle and a pain-free patch fashion. Pain should never exceed a 3/10 on the analog scale.
The distinction is made between plantar fasciopathy and plantar fasciitis with the former being more of a degenerative condition and the latter an inflammatory one. Palpation and thickening of the central portion of the planter fascia is emphasized in fasciopathy.
A link to some downloads with handouts, instruction, etc. is also provided within the podcast.
Rehabilitative exercises focus on increasing loads. A simple calf raise with the toes of dorsiflexion using a town introduced. The patient begins with three sets of 12 RM done every other day for a few weeks with increased to an eight RM as they get stronger. Repetitions are three seconds up, hold for two seconds, three seconds down, hold for two seconds.
The pros and cons of this exercise are discussed: in short if you need high tensile loads across the plantar fashion then this exercise is key. This would be more for chronic conditions rather than acute ones which would probably require rest rather than loading. Up to six months the high load strengthening exercises seem to be superior to stretching and simple he’ll inserts, but after six months there appeared little difference between the two. Speculation was that most people probably discontinue the exercises because they were feeling better.
People that were more active or engaged in sports, at least in this RCT, seem to do better than folks that had the fascia apathy due to having a high BMI.
One study they cite looks at intrinsic musculature of the feet and legs as a contributing component to chronic plantar fasciopathy. It’s emphasized that an individualized program be designed for each patient.
All in all a nice evidence-based lecture/interview with some great clinical pearls. Consider adding a progressive loading program to your planter fasciopathy patients and perhaps consider adding intrinsic muscle exercises well.