Video
Definition
Plantar fasciitis is a common cause of heel pain. It is a frustrating disorder due to its resistance to treatment.
Aetiology
Epidemiology
Anatomy
- Plantar fascia extends from calcaneal tubercles to MTPs + bases of the toes. It covers the intrinsic musculature + NV structures
- Passive MTP dorsiflexion places the inelastic plantar fascia under tension thereby elevating + stabilising the longitudinal arch = windlass effect
- Tensile forces are concentrated at the calcaneal origin
Pathology
Classification
History
- Morning + start up pain.
- Initial pain relief with walking, but after prolonged walking pain recurs
- Pain localised to plantar fascia origin at medial calcaneal tubercle
- Bone scan = ↑uptake at plantar fascia origin
- Risk factors
- repetitive stress, obesity, middle age
- cavus foot 2˚ ↓hindfoot + ↓midfoot motion
- pes planus + TA tightness
- no evidence
- acute injury,
- heel spurs,
- bone spurs form superior to the plantar fascia and not within
- shoe type,
- walking surface,
- occupation
Examination
Investigations
To exclude other pathology
- Numerous causes for subcalcaneal heel pain
- Bilateral
- ?seronegative arthropathy
- ankylosing spondylitis, Reiter’s
- ?seronegative arthropathy
- Neuropathic arthropathy
- diabetes + alcohol
- Vascular insufficiency
- Calcaneal stress #
- positive squeeze test = pain
- Bilateral
Differential Diagnosis
- Numerous causes for subcalcaneal heel pain
- Bilateral
- ?seronegative arthropathy
- ankylosing spondylitis, Reiter’s
- ?seronegative arthropathy
- Neuropathic arthropathy
- diabetes + alcohol
- Vascular insufficiency
- Calcaneal stress #
- positive squeeze test = pain
- Bilateral
Treatment
- No single method stands out as superior
- Stretching
- NSAIDs
- Heel cushion
- Steroid injection (no more than 2 per side)
- Casting. Success related to enforced rest?
- Surgery. No consensus on optimal procedure