Oh, My Aching Feet
Treating Plantar Fascitis

How many times have we run into the patient who complains of plantar heel pain upon bearing weight first thing in the morning? This symptom may be a sign of plantar fascitis, an inflammatory condition involving the broad tendon sheath which runs longitudinally along the bottom of the foot. Symptoms may present either gradually or suddenly without no apparent cause.

Plantar Fascitis is an overuse syndrome which occurs when the fascia is placed under abnormal stress, which commonly occurs with hyper or hypo pronation. Symptoms usually develop around the origin of the fascia, with point tenderness found on the plantar anteriomedial aspect of the calcaneus.

Physical therapy modalities such as ice, ultrasound, iontophoresis and cross friction massage may help reduce acute symptoms. The patient is instructed to pre form stretching exercises of the calf group and plantar fascia, while ladies are asked to avoid heeled shoes.

The Permanent Cure

Having worked with many of these patients over the years, i have found that the most effective and long lasting results are found with the wearing of customized orthotics which help to balance abnormal forces on the plantar fascia. With the correct device inserted into the show, symptoms will resolve within the first week of wear.

Treating the Patient with lower back pain - A common sense approach

We've all heard the statistics telling us that lower back pain is the most common ailment among the adult population, costing industry billions of dollars in medical bills and lost man hours. Early intervention in any injury is crucial to preventing a chronic disability, and the lower back is no exception. Physical therapy which includes specific patient instruction on how to prevent further injury can be of significant value when treating these individuals. From one therapists perspective, here are some answers to commonly asked questions.

What is the most important role of Physical Therapy in treating LBP?

Teaching the patient how they can prevent further injury and designing an exercise program which is appropriate for their specific back dysfunction is the most important role of a physical therapist. Modalities are used to relieve local inflammation and reduce muscle spasms, but without a sound home program for which the patient can follow, recovery may be delayed or incomplete. Areas such as lifting techniques, sitting postures and ergonomics, transitional movements, along with flexibility and strengthening exercises are all important components of a home program. Some patients may only need a good home program in order to make a quick full recovery.

Which protocol is best, McKenzie Williams, Back School, or a combination of all three?

Here's where the common sense approach really takes over. A thorough evaluation will usually steer the therapist in a direction which will frequently use a combination of techniques which were spawned by different philosophies. Many think of McKenzie as extension and Williams as flexion exercises, but those who follow the McKenzie protocols know that flexion is often as important component in treating LBP. As we age our intervertebral discs tend to lose their water content and hence their height, which may lead to facet joint over-riding. this may be one reason why elderly patients usually respond better to williams flexion as opposed to extension protocol, especially when radicular symptoms are present. Dynamic stabilization exercises are important in reconditioning muscles's and improving joint proprioception, while the spine is maintained in a neutral position. Abdominal and paraspinal strengthening are often critical in preventing the re-occurrence of lower back symptoms.

What other areas of the body may attribute to Lower Back Pain?

Many times we'll find that other areas of the body may be the primary cause of LBP. Leg length discrepancies, hip pathology, and foot abnormalities may all lead to lower back compensation and eventual pain and stiffness. correction of abnormal bimechanics will often resolve lower back symptoms.

Summary

We find that an eclectic, common sense approach with good home instruction leads to excellent long term results.