Box 3. Foot taping
Repeat this taping pattern two to five times
depending on how much support you want,
but two to three times is usually sufficient. For
the best results, a rigid type of tape, such as
Strappel or Leukoplast, should be used. For
more information visit: sheffieldachesandpains.
com/foot-and-ankle/foot-pain
Intrinsic foot muscles
These play an integral role in supporting
the arches of the foot. Recently, a new
theory has been proposed to assist our
understanding of intrinsic foot muscle
function – the foot core system. The intrinsic
foot muscle test evaluates the ability to
maintain a neutral foot posture during single
leg standing. Box 5 illustrates the test.
Intrinsic foot muscle test
The client’s foot is placed into subtalar
joint neutral (palpate either side of
the head of the talus, just in front of
the ankle until it feels equally prominent on
both sides). With the heel and forefoot on
the ground, the client lowers their toes
to the ground and is asked to maintain
this position for 30 seconds. Changes
in foot position and over-activity in the
extrinsic leg muscles are observed. Early
studies suggest this can be used to detect
improvements in foot core function. The
short foot exercise (Box 6) can isolate the
contraction of the intrinsic foot muscles
and there is increasing evidence suggesting
it can improve foot function. However,
this is a prolonged standing exercise
(30 seconds in duration), so its impact on
the client’s symptoms need to be evaluated.
If it aggravates, then a non-weight-bearing
alternative should be considered. Over time,
the client may be able to progress to the
standing exercise.
Short foot and non-weight-
bearing intrinsic foot exercises
Roll the toes over the ball and try and grip
Box 4. Stretches and eccentric exercises
Heel raise start and finish position.
From the start position raise
the heel as high as possible.
Perform three sets of 15
repetitions; the trainer needs
to monitor their client. The key
part of the exercise is to lower
the heel back down to the start
position.
Achilles and
plantar fascia stretch.
Box 5: Muscle test
the ball, holding for one to two seconds, 15
reps, three times.
Box 5: Muscle test
Other treatments
If symptoms persist, then it would be wise to
refer on for medical advice, where a thorough
assessment and diagnosis can be made.
Other mechanical therapies include night
splints (to stretch the Achilles and plantar
fascia) and aircast boot (to off-load and
rest the foot). Symptom-focused treatments
include: acupuncture (limited evidence);
extra corporeal shock wave therapy (safe,
with evidence showing short-term benefits;
however, the NICE guidelines advise its
efficacy is inconsistent); steroid injection
(there is evidence to show it is effective in
the short term, i.e., one month, but not in
the long term, and also there are concerns
over repeated use, e.g., risk of rupture);
surgery (mixed results and is considered
a last option; most surgeons will advocate
exhausting conservative measures first).
Box 6: Foot exercises
Summary
Plantar fasciitis is a common foot injury, with
the majority resolving within 12 months. Most
effective treatments can be self-applied,
but input and monitoring of load could be of
use to the client. If persistent, then refer on
for further medical input.
Jai Saxelby
Jai is an enhanced role musculoskeletal podiatrist
working for PhysioWorks-Sheffield Teaching Hospitals
NHS Foundation Trust. He has 28 years’ clinical
experience and has published several papers on
plantar fasciitis. As 15-20% of his case load relates to
this condition, he’s dealt with a lot of painful heels.
Standing short foot exercises.
Non-weight-bearing ball exercises. Perform
3x15 rolls and holds (hold for one to two
seconds), twice daily.
Feature republished courtesy of fitpro.com
NETWORK WINTER 2019 | 51