Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
Summary: Plantar fasciitis is a repetitive microtrauma overload injury of the
attachment of the plantar fascia at the inferior aspect of the
calcaneus. Several etiolog-ical factors have been implicated in the
development of plantar fasciitis; however, the role of hamstring
tightness has not been evaluated.
Methods: Fifteen volunteers (mean age
32.6 ± 4.7 years) were prospectively analyzed for differences in
forefoot loading using a Don-Joy brace (dj Orthopedics, Vista, CA)
applied to each knee simultaneously. The brace was locked at varying
degrees of knee flexion (0 degrees, 20 degrees, and 40 degrees). Their
mean popliteal angle was 6.5 degrees. Fifteen patients (mean age 40 ±
16.5 years) with a diagnosis of chronic plantar fasciitis were
similarly analyzed on the pedobaro-graph. These patients also had their
hamstring tightness evaluated by measuring the popliteal angle. The
mean popliteal angle was 23 degrees.
Results: Increasing the angle of
flexion from 0 to 20 degrees at the knee joint led to a statistically
significant increase in pressure in the forefoot phase by an average of
0.08 K/cm2s (p < 0.05). An increase from 20 to 40 degrees led to
increased forefoot phase pressure of 0.08 kg/cm2s (p < 0.05). The
percentage of time spent in contact phase decreased from 35.37% to
30.87% to 26.37% with increasing flexion (p < 0.05). However there was
an inverse increase in the time spent in the forefoot phase 46.6% to
55.6 to 61.25% with increasing degrees of flexion (p < 0.05).
Conclusion: The results indicate that an increase in hamstring
tightness may induce prolonged forefoot loading and through the
windlass mechanism be a factor that increases repetitive injury to the
plantar fascia.
It is interesting to read the intensity of short-term studies relating to the aetiology of plantar fasciitis. In this study only 15 patients with chronic plantar fasciitis were compared to 15 volunteers. Although statistical differences were observed one must be cautious with the results.
From a statistical view point there is a likelihood of a type 1 statistical error and from a clinical perspective only 15 patients may not reflect the general population.
I am glad that further research is continuing in this area but until a large longitudinal study is undertaken evaluating all intrinsic and extrinsic risk factors...the aetiology of this condition will remain elusive.
I don't know how significant hamstring tightness would really be with patients with plantar fasciitis, relative to other factors.
I mean, if they've got gastro-soleus tightness, they're running around in pluggers all day, or they are 40 kgs overweight for example, is hamstring tightness particularly significant??
Has anyone ever found hamstring tightness to be clinically significant in any patients with plantar fasciitis?
Sorry, probably shouldn't be so negative! Someone obviously put in some effort to do this study for a reason.
Hamstring tightness is something I test in all my patients. Nearly all my patients that present with PF have a degree of hamstring tightness and a referral to a Physiotherapist is part of my treatment protocol.
Most, commonly, also present with FHL/abductory twist/early heel rise. Something definately worth doing some serious thinking about/study into when I get some time!!
Could someone please explain to me why it would be part of standard protocol to refer a patient for hamstring tightness to a PT?
No disrespect to the PT's here, but does this require referral. Sure you find something neural on loading or you suspect a radicular pattern of presentation then refer them out, but as standard protocol?
Maybe this is part of the reason why so many other professions encroach on 'podiatric' conditions. Why even consider the podiatrist when you will end up with another health professional who can treat both the foot and hamstring?
Oh and i do need a manager for my track career if anyone is still interested.Someone did express interest previosuly. I have a big selection meet coming up next month. Let's just say things are looking good for team selection. I cannot say too much but my threshold training may have been the killer to get me there. As long as my hamstring induced plantar fasciitis doesn't prevent me from running all should go well.
May the Broncos destroy the Patriots!
DaFlip
Could someone please explain to me why it would be part of standard protocol to refer a patient for hamstring tightness to a PT?
No disrespect to the PT's here, but does this require referral. Sure you find something neural on loading or you suspect a radicular pattern of presentation then refer them out, but as standard protocol?
Maybe this is part of the reason why so many other professions encroach on 'podiatric' conditions. Why even consider the podiatrist when you will end up with another health professional who can treat both the foot and hamstring?
Oh and i do need a manager for my track career if anyone is still interested.Someone did express interest previosuly. I have a big selection meet coming up next month. Let's just say things are looking good for team selection. I cannot say too much but my threshold training may have been the killer to get me there. As long as my hamstring induced plantar fasciitis doesn't prevent me from running all should go well.
May the Broncos destroy the Patriots!
DaFlip
Im sorry you're so angry :( However I work in a multi disciplinary team of excellent healthcare professionals that are experts in their area which means 2 things:
1. ""OUR"" patient gets the best possible care/treatment
2. I can let more patients see me cause Im not tied up doing something that I've no need to be doing
If your isolationist practices are beneficial to your patients then good luck.
Very interesting points DaveK. Obviously you took offence to my previous comments. they were not meant to offend, just raise the points that got your response. So thank you!
It appears strange that hamstring tightness equals referral. Where did you get taught this and why? Was it a intro-office decision to do this?
By "our" patients getting the best possible care, i presume it is your opinion referring them to the PT is beneficial in these cases.
Could you explain what criteria this is based upon.
How much hamstring tightness equals referral?
How do you determine if you think this is causative in the presenting case?
I also feel very happy(not mad at all right now) that this frees up time so more people can see you! Lucky them.
Who doesn't have tight hamstrings anyway? I have never come across a pt who isn't clnically tight in their hamstrings apart from Yoga techers and a few elite athletes.
All podiatrists should be able to instruct on atleast a basic stretching program. Doubt the PT profession will feel threatened by by this.
HOW do we define tight?...cause if everyone is tight does this mean no-one is because this is actually normal?......my aren't we touchy about different practice attitudes, no need to play "mines bigger than yours" boys....if you don't have anything constructive to add then......
Regards Phill Carter
HOW do we define tight?...cause if everyone is tight does this mean no-one is because this is actually normal?......my aren't we touchy about different practice attitudes, no need to play "mines bigger than yours" boys....if you don't have anything constructive to add then......
Regards Phill Carter
Phill,
there is no argument here. Mine is bigger.
The point is, as you have also raised, when is tight - tight? But my more relevant questions, which remain unanswered, included when does this require referral and how do we determine if this is causative in cases of plantar fasciitis?
Here is my constructive part, just for Phill and also for DaveK since there has been no response from my questions. If there is:
1.positive neurodynamic assessment suggestive of peripheral neurological entrapment,
2.specific neurological referral pattern from the lumbosacral spine or some suggestion of pathological process occurring in the spine including the thoracic and cervical spine,
3.there is bilateral plantar fasciitis of unknown causative origin but suspected referral pattern,
send them away from the pod office to someone who knows what they are doing with these conditions.
All other cases of 'restricted' hamstring ROM, whatever this is, if believed to be of cause should be able to be managed in office by the pod. Now this leads me to the practice attitude because it is relevant to the patient. Why? Well this may appear to some as a nice little bit of extra clinical income for the practice. You know how it may work......standard intra-office program, all cases of plantar fasciitis, go to the pod, referred to the PT. The business may do very well.
DaFlip
The interesting thing here is the role that neurodynamics/neural tension plays in hamstring tightness and in 'heel pain' - maybe the link is in this between the two and not as the authors of the study in message 1 allege as being altered forefoot loading.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Hamstring tightness and plantar fasciitis
Linear Mode
