REHABILITATION

tify needs and short term or long term orthotic prescription.

Activity modification The ultimate goal of rehabilitation is to return to full activity. Accurate assessment of contributing factors and correction of technique will then allow a graded return to activity. A symptom free baseline level of activity needs to be established eg. 25% of pre-symptom level. This is then repeat- ed 3 times a week, in conjunction with local treatment. If symptom-free after three sessions, this level can be increased by 10%. If symptoms reoccur the athlete is regressed to the pre-increase level for three more sessions. Incrementally training is increased, this can take a few months and accurate reporting of symptoms is vital to prevent tissue breakdown. Gym circuits or non weight bearing pool training may be included to maintain associated whole body and cardiovascular fitness.

Acupuncture Evidence exists that traditional acupunc- ture may be beneficial in the management of plantar fasciitis in conjunction with other modalities (21).

Surgery Ultimately a surgical choice could be con- sidered but only after 1 year and conserva- tive management has failed (4). The con- sequences of surgical intervention which involves partial release of the plantar fas- cia needs to be considered in terms of its impact on function (25).

Other common treatments Recent reviews (3,4) have found little good evidence for numerous other treatments including shock wave therapy, electrother- apy including laser and ultrasound and night splints.

TREATMENT SUMMARY Plantar fasciitis should be thought of not so much as an inflammatory problem but as that of a degenerative nature (16). Emphasises therefore need to be placed on accurate assessment of all contributing factors. Each case can then be considered on an individual basis as the cause is like- ly to be multifactoral. An examination and treatment paradigm that considers all of these factors is imperative. Once these are addressed and symptoms are relieved in activities of daily living, a graded return to training can be initiated.

www.sportex.net THE AUTHOR

Chris Murphy is a chartered physiotherapist and part time lecturer in physiotherapy at the University of Brighton. He is also the director of www.physiouk.co.uk a continuing professional training company for physio- therapists and associated professionals. He has an interest in the foot and ankle and has presented on plantar fasciitis at confer- ences in both England and Scotland.

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Medicine (2nd ed). McGraw Hill 2002. ISBN 0074711083 8. Patla CE and Abbot JH. Tibialis posterior myofascial tightness as a source of heel pain: diagnosis and treatment. Journal of Orthopaedic and Sports Physical Therapy 2000;30:624-632 9. Geiderman WM and Johnson JE. Posterior tib- ial tendon dysfunction. Journal of Orthopaedic and Sports Physical Therapy 2000;30:68-77 10. Meyer J, Kulig K and Landel R. Differential diagnosis and treatment of subcalcaneal heel pain: a case report. Journal of Orthopaedic and Sports Physical Therapy 2002;32:114-124 11. Butler D. The Sensitive Nervous System. NOI Publications 2000. ISBN 064640251X 12. Travell JG and Simons DG Myofascial Pain and Dysfunction: The Trigger Point Manual v. 1.

RESOURCES

■ Cochrane Collaboration - this offers free access to the latest systematic reviews on treatment options for a multitude of conditions. www.cochrane.org

■ Physio Room. This contains a wealth of information and some nice pictures on assessment and treatment of various conditions. www.physioroom.com

■ Rome K and Saxelby J. Assessment and management of plantar fasciitis. British Journal of Podiatry Medicine 2005;8(2):34-44

■ Brukner P and Khan K. Clinical Sports Medicine (2nd ed). McGraw Hill 2002. ISBN 0074711083

■ Harradine P, Bevan L and Carter N. An overview of podiatric biomechanics theory and its relation to selected gait dysfunction. Physiotherapy 2006;92(2):122-127

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