A Simple Guide to Plantar Fascilitis

A Simple Guide to Plantar Fascilitis
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What is Plantar Fascilitis?
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Plantar Fascilitis (also known as Painful Heel Syndrome) is a inflammation of the plantar fascia (which stretch from the calcaneum to the toes) characterised by the pain in the heel especially in the morning and weight bearing exrcises.

It is more common in women.

What are the cause of Plantar Fascilitis?
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The cause of plantar Fascilitis is the non-specific inflammation of the plantar fascia as a result of repetitive injury to the fascia.

In some cases the plantar fasilitis occurs as a result of a calcaneal spur impinging on the fascia.

Both heels can be affected.

What are the symptoms and signs of Plantar Fascilitis?
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Symptoms:

1.Pain in the heel of one or both feet

2.Pain usually is worse in the morning on getting and stepping on the floor.

3.Certain weight bearing exercises like jogging or brisk walking makes the pain worse

4.Pain is described as constant and aching

5. Pain is felt most beneath the calcaneal bone but may be present in the area of the medial arch.

Signs:

1.local tenderness in the calcaneal bone area of the heel.

2. Pain is aggravated by direct pressure.

3. It can become more painful by movement which put thethe fascia under strain such as dorsiflexion of the toes or ankles.

4.Xrays of the heel usually show no abnormally. Sometimes there is calcaneal spur which may be due to traction of the muscle or fascia on the calcaneum bone.

A stress fracture may need to be ruled out in chronic cases.


What is the Treatment of Plantar Fascilitis?
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Conservative treatment:
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Initial phase:

1.rest of the heel-avoid jogging or strenous exercises

2.Cold or ice may help reduce inflammation

3.Heel cups, cushions, tapes, pads may help to reduce the pain

4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

5.Muscle relaxant to relax muscles

6.injection of local anesthetic and long acting steroid into the tender area of the plantar fascia may help to relieve pain.

7.Usage of a short leg walking cast for a few weeks help to avoid exertion on the inflamed fascia.

8.A cushion lined night splint which hold the foot in slight dorsiflexion is helpful.

Mobilisation phase:

Physiotherapy such as traction of the fascia and heel cord, shortwave diathermy may help once there is no pain

Surgery is usually not indicated in plantar fascilitis.

Rarely surgery is used to remove the calcaneal spur and to release the plantar fascia at its attachment to the calcaneum bone.


What is the prognosis of Plantar Fascilitis?
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Prognosis is usually good although healing is slow and takes up to 1-2 years.


What is the prevention of Plantar Fascilitis?
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Avoid certain weight bearing exercises like jogging or brisk walking

Use heel cups, cushions, tapes, pads in foot wear

Lose Weight

A Simple Guide to Knee cap Dislocation

A Simple Guide to Knee cap Dislocation
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What is Knee cap Dislocation?
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Knee cap Dislocation is when the knee cap (patella) moves or slides out of place. This usually occurs on the outer side of the knee.


What are the causes of Knee cap Dislocation?
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1.Dislocated knee caps most often occur in people with loose joint ligaments.

It can occur due to sudden strain on the knee ligaments causing the kneecap to protrude out of its loose ligaments.

2.Dislocation of the knee cap may also occur due to trauma.

A sudden blow to the medial part of the knee can cause the knee cap to dislocate laterally.

3.People who are prone to dislocated knee caps usually have loose ligaments with hyperflexion of the wrists or flat feet.

This condition is usually inherited and are more common in women than in men.


What are the symptoms and signs of Knee cap Dislocation?
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Symptoms:

1.Knee cap is displaced to the lateral position

2.knee swelling and effusion due to displacement of the knee cap.

3.Knee pain and tenderness is present.

4.The knee is usually held in slight flexion.

5.There is difficulty in lifting the leg

6. Patient usually walks with a limp.

Signs:

1.Tenderness and swelling of the knee

2.Knee cap is displaced to the outside or lateral part of the knee

3.In most cases the knee cap may have returned to the central position of the knee but there is still tenderness and swelling.

4.The knee cap can move excessively from right to left.(hypermobile)

How to investigate the cause of Knee cap Dislocation?
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1.examination of the knee would confirm presence of the dislocated knee cap.

There is lateral displacement of the knee cap and swelling of the knee.
Movement of the knee may be painful.

2.A knee x-ray should be done to exclude any fracture especially in the case of injury or in the elderly.

A skyline view of the knee should show the shift of the patella laterally.

3.MRI of the knee can be done to see any damage in the cartilage or meniscus of the knee.


What is the Treatment of Knee cap Dislocation?
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Conservative treatment:
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1. Most cases of knee dislocation can treated by simple reduction of the dislocated knee cap.

The heel of the leg is lifted to extend the knee and flex the hip thus relaxing the quadriceps muscles(front muscles of the thigh)

Gentle pressure is exerted on the knee cap to place it to its normal position.

The knee is then immobilized for 2-3 weeks.

Quadriceps exercises are begun as soon as possible to build back your muscle strength and improve the knee's range of motion.

Drug Therapy:
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1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

2.Muscle relaxant to relax muscles

Surgery:
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Surgery is required if:

1.the knee remains unstable

2.Injury of the knee cap cause a partial rupture of the medial retinaculum and supporting ligaments of the knee cap.
This can cause recurrent episodes of subluxation or dislocation of knee cap.

Surgery is done to stabilize the knee cap.
Reconstruction of the quadriceps extensor muscles is done to tighten the ligaments surrounding the knee cap.


What is the prognosis of Knee cap Dislocation?
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Prognosis using conservative methods is fair.

Recurrences are quite common.

Preventative measures such as knee guard, quadriceps exercises, avoidance of sudden turns and twisting of the knee may help.

Prognosis after surgery is usually good as there is tightening of the knee cap ligaments and the quadriceps muscles.


What is the Prevention of Knee cap Dislocation?
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1.proper technique when exercising.

2.Maintain strength and flexibility of the knee by exercising the quadriceps muscles.

3.Wearing a knee guard