Assess
& Address: Plantar
Fasciitis
by Whitney Lowe |
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Assessment
and evaluation
Massage practitioners are likely to see clients with plantar
fasciitis, so proper assessment of this condition is important.
The most common complaint of a client with plantar fasciitis is
sharp pain felt on the bottom of the foot. The client may indicate
that the pain is localized near the anterior calcaneus where the
plantar fascia attaches.
Maintaining
tissues in a shortened position for long periods will often aggravate
the symptoms. For example, a person with this condition will often
sleep with his/her foot in plantar flexion. This position will
keep the fascial tissues of the plantar flexor "sling"
(including the plantar fascia) in more of a shortened position.
When arising in the morning, weight is placed on the foot, providing
a sudden tensile load to tissues that have been in an unloaded
position all night long. Thus, clients will most commonly report
the worst pain sensations as those felt first thing in the morning
upon arising and just starting to walk after getting out of bed.
Plantar
fasciitis is evaluated through an accurate history and physical
examination. In the history, pay particular attention to descriptions
of vigorous activity performed on an unyielding surface. Examples
include running on pavement, aerobic dance classes on a hard floor,
or walking on a hard surface all day. Also pay particular attention
to the location of the key symptoms, as the client is most likely
to report the primary pain on the bottom of the foot and exaggerated
pain near the calcaneal attachment of the plantar fascia.
We
also must consider that a bone spur may be present in the region,
though we may not be able to palpate it. Although X-rays can identify
the bone spur, they are not often used because they only provide
information about the presence of the bone spur and not about
the state of the plantar fascia. Presence of the spur may be indicative
of excessive tensile loads on the calcaneus but does not necessarily
mean the client has plantar fasciitis. Therefore, sound clinical
judgment is considered the best tool for accurately evaluating
this condition.
References