Dr. DeHeer's thoughts on the "Association Between Plantar Fasciitis and Isolated Contracture of the Gastrocnemius"

Article: Association Between Plantar Fasciitis and Isolated Contracture of the Gastrocnemius
Amar Patel and Benedict DiGiovanni Foot Ankle Int 2011 32: 5
DOI: 10.3113/FAI.2011.0005
Abstract Link: http://fai.sagepub.com/content/32/1/5.short


Key Points:

  1. Plantar fasciitis accounts for 11-15% of all foot related medical visits (>1,000,000 outpatient visits/year)
  2. Etiology of PF - multifactorial
  3. Limited ankle joint dorsiflexion has been shown to be a risk factor – proper technique is important when measuring
  4. This prospective study examined the prevalence of association between gastrocnemius equinus and plantar fasciitis
  5. Definitions –
    1. Isolated gastrocnemius equinus – AJ DF < 5° with knee extended and >10° with knee flexed
    2. Gastrocsoleal equinus – AJ DF < 5°with knee extended and < 10° with knee flexed
  6. 254 patients with either acute (< 9 mos. duration) or chronic (>9 mos. duration) plantar fasciitis
  7. 83% (211 of 254) had some form of equinus
    1. Acute PF – 83% (129 of 155)
    2. Chronic PF – 82% (82 of 99)
  8. Gastrocnemius equinus
    1. Acute PF – 60% (93 of 155)
    2. Chronic PF – 52% (52 of 99)
  9. Gastocsoleal equinus
    1. Acute PF – 23% (36 of 155)
    2. Chronic PF – 30% (30 of 99)
  10. No statistical significant difference in distribution of contracture type
  11. Patients with Gastrocsoleal contracture were older than those with isolated gastrocnemius contracture (52.9 years to 46.2 years p=0.02)
  12. Clinical examination of gastrocnemius equinus had a high correlation with goniometric evaluation
  13. The high prevalence of equinus associated with plantar fasciitis can be utilized to improve patient outcomes both non-surgically and surgically

    Dr. DeHeer’s Opinion: It is very clear from this study that any comprehensive treatment plan for plantar fasciitis patients with an associated equinus deformity must include treatment of said equinus deformity. In the emerging and changing world of healthcare where outcome based payment models will determine physician reimbursement, aggressive equinus management will result in improved outcomes for patients suffering from plantar fasciitis. Equinus therapy should be initiated immediately and continued until deformity resolution (typically between 8-12 weeks). The goal of therapy should be ankle joint dorsiflexion >5° with the knee extended. Many patients will require ongoing maintenance therapy once the equinus deformity is corrected. Just as the article states the etiology of plantar fasciitis is multifactorial, the treatment should be as well.

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