TO COMPARE THE EFFECTIVENESS OF
PLANTAR FASCIA STRETCHING AND
ULTRASOUND IN YOUNG ADULTS WITH
PLANTAR FASCIITIS
S. JAYA PRAKASH 4th BPT
INTRODUCTION
• The plantar fascia (PF) can undergo a form of pathological
degeneration called plantar fasciitis that is one of the most common
causes of heel pain. [john ebnezar 4th edition]
PREVALENCE
• Plantar fasciitis (PF) is one of the most common disorders of the
foot and approximately 11–15% of adults with severe symptoms
that require professional care. Within the general population, the
incidence of PF typically peaks between 40–60 years of age.
However, the pathogenesis of plantar fascia is currently not well
understood. Nonetheless, one of the most common causes
includes tightness of the calf muscles and/or Achilles tendons.
• Around 1 in 3 people get plantar fasciitis in UK.
. In USA it is estimated that more than 1 million.
ANATOMY
The PF were a mean 2 and 6 cm crosswise (approximately) at
the proximal and distal ends, respectively, and 12 cm lengthwise
from the medial tuberculum to the metatarsophalangeal joint.
The PF was firmly attached to the superficial muscles of the sole, particularly
in the proximal insertions. Distally, some perpendicular septae were detached
from the PF and enveloped the tendons of the abductor hallucis and the four
tendons of the flexor digitorum brevis. Various compartments for the tendons
were thus formed, closely connected to the PF.
AIM
The aim of the study is to find out whether stretching or ultrasound is
effective to reduce PAIN and improve QUALITY OF LIFE in patients
with Plantar fasciitis.
OBJECTIVE OF THE STUDY
To find out the effects of STRETCHING EXERCISES to reduce pain
improve quality of life in patients with plantar fasciitis.
To find out the effect of ULTRASOUND to reduce pain and improve
quality of life in patients with plantar fasciitis.
OPERATIONAL DEFINITION
• PLANTAR FASCIITIS
This is defined as pain on the plantar surface of the heel and is the
most common cause of posterior heel pain
Plantar fasciitis is an aseptic inflammation of the plantar fascia at its
origin at the calcaneum. It causes pain in the foot anterior to the
attachment of the plantar fascia.
• STRETCHING EXERCISES
Stretching is a general term used to describe any therapeutic maneuver
designed to increase the extensibility of soft tissues, thereby improving
flexibility by elongating (lengthening) structures that have adaptively
shortened and have become hypomobile over time.
• ULTRASOUND
Sound is by definition the periodic mechanical disturbance of an elastic
medium such as air, sound requires a medium for its transmission and
cannot cross a vacuum in the way electromagnetic waves can. An oscillating
source, such as a tuning fork, is required to produce sound waves. The
frequency of the sound wave is the same as the rate of oscillation of the
source and remains the same from medium to medium. Sound waves are
travelling pressure waves in the medium which cause an alternate
compression and rarefaction (moving apart) the particles in the medium. It
is therefore only the form of the wave which moves forward; the actual
particles merely vibrate back and forth, each about a mean point.
Propagation of the sound wave depends upon the transmission of energy
from particle to particle, and as this is not 100 per cent efficient, energy is
lost at each transfer (attenuation).
HYPOTHESIS
• NULL HYPOTHESIS
• There would not have been any significant improvement in
reducing pain and quality of life in patients with plantar fasciitis.
• ALTERNATE HYPOTHESIS
• There would have been significant improvement in reducing pain
and quality of life in patients with plantar fasciitis.
REVIEW OF LITERATURE
• HATAITIP BOONCHUM et al. (2020)
CONCLUSION: state that home base stretching exercise was an effective
program for reducing pain, enhancing function and muscle strengths of both
extrinsic and intrinsic foot muscles in patients with plantar fasciitis.
LINK:http://www.ncbi.nlm.gov/pmc/article/PMC7493445/#_ffn_sectitle
• DEVRIM OZER et al. (Dec 2015)
• CONCLUSION: Plantar fascia specific stretching exercise is an effective
treatment option for plantar fasciitis.
• LINK:10.4274/haseki.2479
• SUTHASINEE THONG et al. (2019)
CONCLUSION:Both strengthening and stretching exercise programs
significantly reduced pain and improved gait in patients with PF
LINK:https://doi.org/10.5535/arm.2019.43.6.662
• AKKRADATE SIRIPHORN et al. (13,Jun 2020)
• CONCLUSION: There was moderate to very low-quality evidence of
the effectiveness of stretching for PF. The treatment effect of
stretching was large and comparable to other.
• LINK:https://doi.org/10.1016/j.jbmt.2020.06.013
• PHOOMCHAI ENGKANANWAT et al. (Jan 2018)
• CONCLUSION: The simultaneous stretching of the Achilles tendon
and plantar fascia for 4 weeks was a more effective intervention for
plantar fasciitis. Patients who reported complete relief from symptoms
at the end of the 4 week intervention in the simultaneous stretching
group were double that of the stretching of the Achilles tendon only
group.
• LINK:10.1177/1071100717732762
• DANILO H. KAMONSEKI (Oct2015)
• CONCLUSION: The three different exercise protocols achieved
similar improvements in pain,Patients with PF. Thus, strengthening &
stretching exercises did not achieve better results in comparison to
stretching alone. The most appropriate frequency and duration of
stretching exercises is still unknown.
• LINK:10.1016/j.math.2015.10.006
• BENEDICT F. DIGIOVANNI, MD et al. (2006).
CONCLUSION:Long-term benefits of the stretch include a marked
decrease in pain and functional limitations and a high rate of satisfaction.
LINK:10.2106/JBJS.E.01281
• RENATA GRACIELE ZANON et al. (2006)
• CONCLUSION: Local application of high-power continuous-mode US
does not add value to functionality and pain relief in chronic PF, especially
in cases with calcaneal spur. Stretching exercises for fascia and leg’s
posterior musculature is efficient for reducing plantar pain and for
functional improvement in chronic PF.
• LINK:14801-150
• DR. AMITAV BANIK et al. (Dec 2019)
• CONCLUSION:That statistically significant improvement can be achieved
by using ultrasound therapy in the treatment of plantar fasciitis
• LINK:: 10.32553/IJMSDR/v3i5.23
• JAMES DUNNING et al. (2018)
• CONCLUSION:The inclusion of electrical dry needling into a program of
manual therapy, exercise and ultrasound was more effective for improving
pain, function and related-disability than the application of manual therapy,
exercise and ultrasound alone in individuals with PF at mid-term.
• LINK: https://doi.org/10.1371/journal.pone.0205405
• ASLIHAN ULUSOY, MD et al. (2017)
• CONCLUSION:The findings from the present investigation showed
that LLLT, US therapy, and ESWT all significantly reduced the pain
with no side effects and provided an objective reduction in fascial
thickness on MRI
• LINK: http://dx.doi.org/10.1053/j.jfas.2017.02.013
METHODOLOGY
• STUDY DESIGN : Quasi experimental study comparative.
• SAMPLING TECHNIQUES : Randomized controlled trail
• SAMPLE SIZE : 30 ( Both Male & Female )Patients
• STUDY SETTING : Sree Abirami Hospital
• STUDY DURATION : 6 months
• TREATMENT DURATION : 4weeks
• INCLUSION CRITERIA
 18-25 years
 Both male and female
 Acute plantar fasciitis
 People who have tested negative for Covid &consented for the
study
 Patients with unilateral plantar fasciitis
pain with tenderness on palpation at the medial tubercle of calcaneus
• EXCLUSION CRITERIA
 Pain medication [corticosteroid injections]
 Chronic plantar fasciitis
 Patients with psychological disorder
 Open wound
 Metal implants
 Allergies
 History of back or lower limb surgery
 Fracture or trauma within 6 months
 Leg length discrepancy greater than 1 cm
 Achilles tendinopathy
 Acute ankle sprains
 Tarsal tunnel syndrome
 Patellofemoral syndrome
• OUTCOME MEASURES
• ASSESSMENT TOOLS
• Foot function index
• Visual analogue scale
• Windlass test
• DATA ANALYSIS
 t test
Paired t test and independent t test
REFERENCE
1.
Harvey Lemont et al. J Am Podiatr Med Assoc
Plantar fasciitis: a degenerative process (fasciosis) without inflammation.
(May Jun 2003)
2. paratenon Carla Stecco,1 Marco Corradin,1,2 Veronica Macchi,1 Aldo
Morra,3 Andrea Porzionato,1 Carlo Biz2 and Raffaele De Caro
Plantar fascia anatomy and its relationship with Achilles tendon
(2013)
Akkradate Siriphorn, Sukanya Eksakulkla –
Calf Stretching and Plantar Fascia-Specific Stretching for Plantar
Fasciitis: A Systematic Review and Meta-Analysis.
(13 JUNE 2020).
BOOKS
1.Orthopeadics and traumatology 8th edition Mayil Vahanan
Natrajan.
2.Therapeutic exercise 5th edition Carolyn Kisner. Lynn Allen Colby.
3. Clayton’sElectrotherapy 9th edition.
4.Textbook of Orthopeadics 4th edition John Ebnezar
SCALES