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Plantar Fasciitis Due to Forefoot Valgus Pathology

Plantar Fasciitis Due to Forefoot Valgus Pathology

Definition

Plantar fasciitis is a generic term to describe mechanically induced heel and arch pain.

Overview

Plantar fasciitis occurs when tension within the plantar fascia increases. This tension is commonly caused by dorsiflexion of the first ray or supination of the long axis of the midtarsal joint. Calcaneal eversion or compensation for an everted forefoot position (either forefoot valgus or plantarflexed first ray) will cause the midtarsal joint to supinate, increasing tension on the plantar fascia.

Clinical Goal for Orthotic Treatment

The goal of orthotic therapy for patients with plantar fasciitis due to forefoot valgus is to decrease tension within the plantar fascia by preventing first ray dorsiflexion and allowing first ray plantarflexion. This is accomplished by raising or supporting the lateral forefoot with a valgus wedge.

Prescription

To prescribe this device check “Plantar Fasciitis due to Forefoot Valgus” under the Pathology Specific Orthoses section (Part A) of the prescription form.

Plantar Fasciitis due to Forefoot Valgus  Prescription Recommendations

  • Polypropylene shell – semirigid
  • Standard Heel Cup
  • Wide Width
    • A wider width increases surface area under the arch preventing arch collapse while plantarflexing the first ray.
  • Minimum Cast Fill
    • Minimum cast fill produces an orthosis that conforms closely to the arch of the foot and aid first ray plantarflexion.
  • EVA Cover to Toes
    • The cover allows the addition of a valgus extension
  • Valgus Extension
    • A valgus extension supports the lateral forefoot decreasing plantar fascia tension

Summary

Based on the best available evidence, plantar fasciitis treatment should reduce tension on the plantar fascia. The orthoses for treating plantar fasciitis due to forefoot valgus should plantarflex the first ray which brings the first metatarsal head closer to the calcaneus reducing plantar fascia tension. It should also support the valgus position of the forefoot.

References

  1. Bordelon RL: Subcalcaneal pain. Clin Orthop 177:49, 1983
  2. Capon, N, Higgs, ER, Dieppe, PA, et al: Arthritis in Behcet’s syndrome. Br J Radiol 56:87,1983
  3. Cheung JT et al: Effect of Achilles tendon loading on plantar fascia tension in the standing foot. Clinical Biomechanics (Bristol, Avon) 21(2):194-203, 2006
  4. Digiovanni BF, et al: Plantar fascia specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up: J Bone Joint Surg 88A:1775-81, 2006
  5. Harty J: The role of hamstring tightness in plantar fasciitis: Foot Ankle Int 26(12) 1089-92, 2005
  6. Kogler GF, Veer FB, Solomonidis SE, et al. The influence of medial and lateral placement of orthotic wedges on loading of the plantar aponeurosis. J Bone Joint Surg Am 81(10):1403-1413, 1999
  7. Lynch DM, Goforth WP, Martin JE, et al. Conservative treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc 88(8):375-380, 1998
  8. Scherer PR. Heel spur syndrome. Pathomechanics and non-surgical treatment. Biomechanics Graduate Research Group for 1988. J Am Podiatr Med Assoc 81(2):68-72, 1991

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