The plantar fascia is an aponeurosis that originates from the medial tubercle of thecalcaneus and extends distally to the phalanges. The Windlass Mechanism is aterm used to describe how the plantar aponeurosis acts like a pulley (Hicks, 1954),developing tension during dorsiflexion of the great toe. This shortens the distance betweenthe calcaneus and the metatarsals, as the aponeurosis winds around the metatarsal headresulting in elevation the medial longitudinal arch. Together with the intrinsicfoot muscles the plantar aponeurosis stabilizes the arch and provides dynamic sensory andmotor control to the foot.In addition to sedentary middle-aged patients, plantar fasciitis isparticularly prevalent in running and dancing activities that require maximal plantarflexion ofthe ankle and dorsiflexion of the metatarsophalangeal joint.

Symptoms are characterized by pain radiating the medial aspect of the heel into the arch offoot. Pain is often most intense with the first steps of the day or after rest or warming up withactivity. As the condition progresses these symptoms can become moredebilitating reducing the patient’s ability to weight bear.

Plantar fasciitis being the most commoncause of rear foot (inferior heel pain) differential diagnosis should not overlook othercommon conditions such as fat pad contusion, and less common conditions such as calcaneal stress and traumatic fractures, medial calcaneal nerve entrapment, lateral plantar nerveentrapment, tarsal tunnel syndrome, talar stress fracture, retrocalcaneal bursitis, along withnot to be missed pathologies such as spondyloarthropathies, osteoid osteoma and post knee orankle injury complex pain syndrome (CRPS Type 1).

There is a broad range of intrinsic and extrinsic riskfactors in the context of PF. The intrinsic risk factors reported were as follows:An excessive body mass index (BMI), reduced toe plantar flexion and restricted ankledorsiflexion, reduced eversion and inversion mobility, Achilles and tibialis tendon disorders,excessive pronation, pes planus or cavus and weakness or disturbances in the intrinsic andplantar foot muscles. The extrinsic risk factors reported were as follows: excessivephysical activity, poor-quality footwear, inadequate surfaces or even walking barefoot. Intrinsic foot muscles (IFMs) play a key role in providing movement and stability tothe ankle and foot; for example, they act as a support for the foot arches. IFMs, such asthe abductor hallucis brevis (AHB), flexor digitorum brevis (FDB) and quadratus plantae(QP), also coordinate with the extrinsic foot muscles, in order to transmit force and mobilityto the foot, and to modify foot stiffness. Therefore, these soft tissue structures havebeen considered a target for study and assessment, due to their importance in the diagnosisand management of ankle and foot disorders.

Plantar fasciitis is more common in middle aged obese women and young athlete’s male. It takes place in patients whose lifestyle causes irregular stretching of the plantar fascia, repetitive microtrauma in runners, prolonged standing and heel spur. Weakness of the extrinsic and intrinsic foot muscles may result in recurrent symptoms of plantar fasciitis as a result of improper joint positioning and functioning of the muscle during walking.Diagnosis of patient with plantarfasciitis can be made through the patient history, clinical manifestations and objective assessments such as level of pain, muscle tightness, palpation, range of motion of joint or muscle strength. Diagnostic imaging may be used to exclude other causes of heel pain as heel spurs or inflammation of tissues. Understanding the anatomy and kinematics of the ankle and foot, the dynamic and static function of the plantar fasciitis during walking and the contributing risk factors associated with plantar fasciitis aid in developing a proper treatment plan and preventative protocol for this condition.

NEED FOR THE STUDY

Previous research has shown increase incidence of plantar fasciitis across the globe and it is 13.6 % in India.

It is been also proved that there is increase in pain in lower extremity and ankle foot complex, along with difficulty in walking. Research statistics has also shown increase in incidence of pain, deformities and accelerated degenerative processin population having plantar fasciitis.

Pain associated with plantarfasciitis cause impaired foot function,significant gait-related disability andstiffness. Plantar fasciitis, if not treatedsoon or properly after the initialsymptoms, it frequently becomes chronicand difficult to resolve. So, patients withplantar fasciitis are in essential need forrehabilitation exercises program toimprove their condition; reducing painand improving functional recovery andfoot function.

Lack of required strength, functional weakness, foot laxity, neuromuscular imbalance etc. are proven intrinsic risk factors for increase in chances, hence it is imperative to design an optimum corrective exercise program to avoid the risk of plantar fasciitis.

AIM AND OBJECTIVES

Aim: To study the effect of 4 weeks of plantar intrinsic muscle training program on pain and functional recovery in patients with plantar fasciitis.

Objectives:

1. To study the effect of plantar intrinsic muscle training program on pain with NPRS in patients with plantar fasciitis.

2. To study the effect of plantar intrinsic muscle training program on functional recovery with Foot Functional Index Scale in patients with plantar fasciitis.

RESEARCH QUESTION

Will there be any effect of 4 weeks of plantar intrinsic muscle training program on pain and functional recoveryin patients with plantar fasciitis?

Hypotheses

Null Hypothesis (H₀): There will be no significant effect of 4 weeks of plantar intrinsic muscle training program on pain and functional recovery in patients with plantar fasciitis.

Alternative Hypothesis (H₁): There will be significant effect of 4 weeks of plantar intrinsic muscle training program on pain and functional recovery in patients with plantar fasciitis.