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Use of the Tissue Stress Model as a Paradigm for Developing an Examination and Management Plan for a Patient with Plantar Fasciitis

^* Physical Therapist, Department of Physical Therapy, Kaiser Permanente Medical Center, Vallejo, CA 94589.

The opinions and assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of Defense, the United States Air Force, or any other federal agency.

Abstract

This case report demonstrates the use of the tissue stress model to develop an examination, evaluation, and management plan for a patient with an 8-week history of plantar fasciitis. The patient history focused on determining which tissues were being excessively stressed, and the physical examination was used to apply controlled stresses to these tissues and to determine factors contributing to the patient’s condition. After it was confirmed that the patient’s plantar fascia was under excessive mechanical stress, treatment first focused on reducing pain, inflammation, and stress on the plantar fascia and then on returning the patient to her running program while maintaining symptoms at a diminished level. The patient reported being free of pain 7 weeks after the initial physical therapy examination and at the 11-week telephone follow-up. Although no experimental evidence is given, this report suggests that this patient responded positively to treatment based on the tissue stress model. (J Am Podiatr Med Assoc 92(9): 499-506, 2002)