The clinical reasoning process for the intervention of chronic plantar fasciitis

Of the many foot and ankle conditions affecting older adults, plantar fasciitis (PF) can be especially debilitating when present for many months or years. Chronic PF is an inflammatory condition of the foot that can be detrimental to an individual's functional abilities. Chronic PF significantly impacts older adults since pain associated with PF can cause gait disturbances, difficulty with activities of daily living, and balance impairments and increase the risk of falling. This case report describes the physical therapy examination and subsequent interventions using iontophoresis with dexamethasone and traditional physical therapy in an older adult with chronic PF.

The patient was a 61-year-old woman with a 10-year history of chronic PF in the left foot. Physical therapy interventions focused on pain control, flexibility, bilateral and single leg stance tasks, and a progressive home exercise program. The main intervention for pain control was iontophoresis with 4 mg/mL of dexamethasone.

After 8 sessions of physical therapy that included 7 interventions using iontophoresis with dexamethasone, the patient demonstrated consistent improvement despite the chronicity of her condition. She reported an overall decrease in pain from 6-7 of 10 to 3 of 10 and no longer required night splints. She demonstrated increased ankle active range of motion in all planes. Her weight-bearing tolerance improved as evidenced by the ability to comfortably walk for up to 2 hours, chase after her grandson, and negotiate the grocery store without increased left foot symptoms.

Iontophoresis with dexamethasone combined with individualized traditional physical therapy may have contributed to decreased plantar foot pain, increased ankle active range of motion, and improved functional mobility in this older adult with chronic PF.