Date of Award

8-2024

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Steven Halcrow

Keywords

Plantar fasciitis, Plantar heel pain, Plantar fasciosis, Overuse injury, Intellectual disability, Mental disability, Special needs, Evaluation, Treatment, Intervention

Abstract

Introduction. Approximately 10% of Americans deal with plantar fasciitis. Plantar fasciitis can lead to negative impacts on quality of life. Furthermore, treatment of individuals with intellectual disabilities affecting communication presents a unique set of difficulties. This case study summarizes the evaluation process and treatment of one female patient with bilateral plantar fasciitis who also has an intellectual disability.

Case Description. This specific patient was diagnosed with intellectual disability secondary to a carbamoyl phosphate synthetase I (CPS) deficiency at birth. She presented to physical therapy at age 35 with bilateral plantar heel pain of 6 months following an increase in activity levels.

Intervention. Treatment consisted of 2 sessions per week of 45 minutes each for 4 weeks, followed by 1 session per week for 6 weeks. Interventions consisted of passive/active gastrocnemius and plantar fascia stretching, Instrument Assisted Soft Tissue Mobilization (IASTM), static cryotherapy, self-tennis ball plantar fascia massage, hip joint mobilizations, and gastrocnemius strengthening.

Outcomes. Prior to discharge, the patient demonstrated improvements in activity tolerance measured by duration of treadmill ambulation, range of motion, reported pain measured by the visual analog pain scale, and participation in activities.

Discussion. Throughout the duration of this case study, it was found that the patient responded well to passive treatments early into the treatment series such as passive stretching, IASTM, and cryotherapy. Communicating pain was a major barrier to treatment. This was overcome by using the visual analog pain scale to quantify pain intensity. Duration of treadmill walking was useful to assess activity tolerance and track progress. Range of motion slowly improved over the 10 weeks; supporting the use of passive and active stretching. This case study supports the literature on plantar fascia by supporting the use of increasing range of motion and slowly increasing activity levels. It adds to the current literature by providing more information on how to alter treatment and use of objective measures for individuals with intellectual disabilities as this is an area where the literature is lacking. Further research would be useful for the evaluation and treatment of individuals with intellectual disabilities who are dealing with overuse injuries.

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