Plantar Fasciitis

Plantar Fasciitis

Plantar fasciitis is the result of collagen degeneration of the plantar fascia at the origin, the calcaneus tuberosity of the heel, as well as the surrounding perifascial structures. The plantar fascia provides support to the arch of the foot, shock absorption, and plays an important role in normal biomechanics of the foot.

 

The plantar fascia is comprised of white longitudinally organize fibrous connective tissue that originates on the periosteum of the medial calcaneus tubercle (inside side of foot towards the heel) and extends along the bottom surface of the foot and separates to surround the 5 flexor tendons of the toes. It blends within the tendon sheath of the Achilles’ tendon, the intrinsic foot musculature, skin, and subcutaneous tissue.

 

Etiology

Plantar fasciitis is often an overuse injury that is due to repetitive strain causing micro-tears of the plantar fascia, but can also be caused by trauma or other multi factorial causes. It may present bilaterally in 1/3 of cases. Often characterized by calcaneal heel spur and/or calluses at the metatarsal heads.

 

Risk Factors

  • Pes cavus (high arches) OR pes planus (low arches) deformities

  • Excessive foot pronation dynamically

  • Impact/weight-bearing activities such as prolonged standing, running, etc

  • Improper shoe fit

  • Diabetes Mellitus

  • Tight Achilles’ tendon

  • Different leg lengths

  • Obesity

  • Females slightly more commonly than males

 

Clinical Presentation

  • Heel pain with first steps in the morning or after long periods of non-weight bearing

  • Tenderness to the anterior medial heel (inside part of the foot, up toward the heel)

  • Limited dorsiflexion (pulling toes/top of foot up towards ceiling) and tight Achilles’ tendon

  • Pain with dorsiflexion passively

  • Possible limp or toe walking

  • Pain increased when barefoot on hard surfaces and with stair climbing

  • Sudden increase in activity level prior to onset of symptoms

  • Special Test: Windlass test

  • Pes cavus or pes planus

Medical Management

Conservative measures are always the first choice

  1. Rest from aggravating activity guided by pain level

  2. Ice after activity

  3. Deep friction massage

  4. Shoe inserts or orthotics

  5. Night splints

  6. Iontophoresis (ionic medication delivered through electric currents)

  7. Education on proper stretching and rehab
     

Rehab

  1. May take weeks or even months to improve (depending on the circumstances)

  2. A Home Exercise Program so that the patient may continue working on progress at home is essential

  3. Stretching and strengthening of: gastrocnemius/soleus (calf muscles)

  4. Fascia rolling exercises (golf ball, tennis ball, therabar, etc.)

  5. Big toe extension stretching

  6. Addressing too high or too low arches if necessary

  7. Stretching or strengthening intrinsic foot musculature as necessary
     

If pain does not respond to conservative measures, more advanced or invasive techniques may be tried such as extracorporeal shock-wave therapy, steroid injections, or surgery.

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