Plantar Fasciitis

Plantar fasciitis is one of the most common problems treated in a foot and ankle practice.

Approximately 10% of the United States population experiences bouts of heel pain.

The plantar fascia acts like a windlass mechanism.

The plantar fascia is made up of 3 distinct parts: medial, central, and lateral bands.

It extends from the heel bone to the metatarsal heads.

The plantar fascia is a thick band of tissue in the arch of the foot.

Etiology

Biomechanical dysfunction of the foot is the most common origin of plantar fasciitis.

The pathology is believed to be secondary to the development of microtears in the fascia

There is an inflammation at the fascia at its origin due to repetitive strain of the arch with weight bearing.

Symptoms
Most common complaint is pain in the bottom of the heel. Patients will typically present with post–static dyskinesia. Pain with the first steps out of bed or periods of rest so it is usually worst in the morning and may improve throughout the day or with more activity.

By the end of the day the pain may be replaced by a dull aching that improves with rest.

Most people complain of increased heel pain after walking for long periods of time.

Generally the most common pain is that elicited upon palpation of the plantar-medial calcaneus

This is at the site of plantar fascial insertion to the heel bone. Pain can occur also at the central and sometimes at the lateral insertion as well.

A tight Achilles tendon can be an adjunctive finding and can contribute to the heel pain. This is known as an Equinus.


Diagnosis
Generally the diagnosis can be made with a good history.

X rays , MRI, and ultrasonography are important modalities to the diagnosis of plantar fasciitis.

X rays may reveal a plantar heel spur, which show the presence of abnormal stresses across the plantar fascia

A heel spur forms in a manner consistent with Wolff’s law. It should be noted that the heel spur is not the cause of the symptoms and therefore does not need specific treatment or removal.

MRI and ultrasonography shows the thickness of the fascia and helps rule out other problems that are not visible with x rays .

Treatment

Nonsurgical treatment include/ Conservative:

• Rest
• Icing
• Stretching
• Nonsteroidal anti-inflammatory medication such as Ibuprofen
  
• Taping/Strapping
• Orthoses (pre molded or custom-made)
  

• Physical Therapy
• Weight Loss
• Corticosteroid Injections
• Night Splints
  

These treatments should be used in combination.

Walking, running, and jumping sports are associated with plantar fasciitis; restriction of these activities may be necessary.

Surgical:

Severe cases may require surgical intervention if conservative therapy does not improve symptoms.

Extracorporeal shockwave therapy (ESWT) is an alternative treatment for chronic heel pain using acoustic-energy shockwaves

Plantar fascia release—performed by transecting part of the fascia - This is performed through an open incision or performed endoscopically

Another relatively new percutaneous technique is Topaz bipolar radiofrequency microdebridement, which applies a bipolar radiofrequency pulse to the plantar fascia.