Abstract
Background and purpose : Plantar fasciitis is a common condition causing medial heel and arch pain and has been related with degenerative changes in the plantar fascia resulting in tissue thickening. This could include proliferation of fibroblasts and a perpetuating inflammatory cycle. The use of IASTM for the treatment of Plantar Fasciitis is currently under review in the literature, however the use of Musculoskeletal Ultrasound for determining treatment location has not been discussed at this time. This case report investigates the management of plantar fasciitis with a Musculoskeletal Ultrasound guided Instrument Assisted Soft Tissue Mobilization in a female runner. Case description: The patient was a 46-year-old female yoga practitioner and runner, who presented with right foot pain. Clinical decision-making within the orthopedic physical therapy treatment process is typically based on the hypothetical-deductive method. The accuracy and reliability of clinical tests affect this reasoning process. Musculoskeletal ultrasound imaging (MSK US) is an emerging diagnostic tool in physical therapy. The clinical impression in this case was based on the combination of the traditional physical therapy examination procedures and dynamic MSK US imaging findings of the plantar fascia demonstrating thickness and tendinosis like changes within the plantar fascia 3 cm distally of the calcaneus. Outcomes: IASTM is a modality that allows clinicians to achieve a localized and deeper penetration of tissues. The mechanical forces caused by the IASTM might result in localized tissue trauma leading to stimulation of the body’s natural inflammation and healing processes. The patient was seen for a total of 8 treatment sessions over 4 weeks, at which time the goal of normal ankle dorsiflexion, no pain with palpation of the plantar fascia, negative windlass test, and she reported no pain during gait were achieved. Discussion: This case report combines the use of ultrasound imaging to guide the decision-making process to provide optimal location for the application of IASTM within the conservative management of a runner with plantar fasciitis. This case report illustrates that complementary research is necessary to both validate the use of IASTM within the management of plantar fasciitis and to further validate MSK US imaging as the preferred method to objectivize tissue quality and guide decision-making.