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Plantar Fasciitis

Plantar fasciitis refers to inflammation or enthesopathy with partial tears of the plantar fascia of the foot. It is considered the most common cause of heel pain.

Clinical features of plantar fasciitis:

Most affected individuals complain of pain along the plantar surface of the foot but also Heel pain. The pain is worsened by pressure on the bottom of the foot (i.e., walking, running, palpation). It is also worse with the first steps taken after getting out of bed in the morning. There is tenderness to palpation at the attachment site of the plantar fascia to the inferior aspect of the calcaneus. Predisposing factors include obesity, pes planus, pes cavus, short Achilles tendon, and standing/running on hard surfaces.

Radiographic features:

Ultrasound: often the initial imaging modality of choice. Ultrasound typically shows increased thickness and a hypoechoic fascia. You may also detect other enthesopathy signs or partial tears

Plain film features are non-specific but may show an show an associated plantar calcaneal spur = enthesophyte, although this is also seen in asymptomatic individuals.

MRI: Signal characteristics of affected tissues include:

• T1/PD: intermediate signal

• T2: high signal

• STIR: very sensitive in the detection of both fascial and perifascial edema, which appear as poorly marginated areas of high signal intensity

Initial therapy:

- Heel cup: consider custom orthotics if foot abnormalities are present

- NSAIDs

- Stretching exercises of the plantar fascia and Achilles tendon

- Avoid weight-bearing exercise

If no improvement after approximately 2 to 3 months, continue the plan above and add:

- Night splint: a removable splint to hold the foot in minimal dorsiflexion while sleeping

- Consider a local prp or hyaluronic acid injection

- Extracorporeal shock wave therapy: maximum improvement seen 3 months after treatment

If no improvement after approximately 6 to 12 months of conservative therapy

-consider a referral for surgery (<10% of patients)


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Web:

WebMD

Runnersworld

MayoClinic

Patient.info

Schulthess Klinik (German)

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