PLANTAR FASCIITIS
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related talks: broken heel bone; flatfoot; broken foot; achilles tendonitis
What is Plantar Fasciitis?
Plantar fasciitis is inflammation of the plantar fascia.
The plantar fascia is a thick band of fibrous tissue on the bottom of your foot that connects the heel (calcaneus) to the midfoot and provides structural support to the arch of your foot.
Overuse (like too much standing or walking), or direct injury to the plantar fascia can cause pain. Its believe that excessive tension on the fascia causes "micro-tears" which in turn causes inflammation and degeneration of the fascia, which leading to pain.
Its a very common condition. About 10% of people will experience this issue during their life.
How is Plantar Fasciitis diagnosed?
Doctors diagnose this condition based on symptoms and physical exam alone (also known as a “clinical diagnosis"). X-rays and MRIs are actually less accurate than a good doctor at determining which people have this condition.
The major complaint is pain at the bottom of your foot, toward the heel. People typically say the worst pain occurs with the first step in the morning, or after a long day of walking.
X-rays are often ordered to rule out other injuries that could cause a similar pain, such as a heel bone stress fracture. Plantar fasciitis wont appear on an x-ray (x-rays are great at showing bone, but dont show soft tissue like ligaments or tendons). Although many times we see a bone spur right near the area of pain, doctors still dont understand its significance because only 50% of cases have it (and this bone spur actually forms in a neighboring muscle tendon, the flexor digitorum brevis, and not actually the plantar fascia itself).
How is Plantar Fasciitis treated?
This condition is usually successfully treated nonsurgically.
Over 90% of cases get better with heel stretching exercises, physical therapy, night splints, anti-inflammatories, and icing.
If pain continues, then some doctors may inject the area with a steroid (be warned that this injection can be pretty painful, but it usually helps to provide at least a few weeks of relief).
If the pain continues and continues for over a year, then many surgeons will recommend a procedure to release ("cut") the plantar fascia (this takes tension off the fascia and this prevents further micro-tearing that causes the inflammation and pain).
What is the long term outcome?
The majority of patients respond very well to nonsurgical treatment.
The few cases that require surgery, also respond very well to the procedure. One of the risks of the procedure is injury to "Baxters nerve" which gives sensation to the inner part of the heel, and it travels very close to the plantar fascia and can be accidentally injured during the surgery.
Reference
1) Neufeld SK et al. Plantar fasciitis: evaluation and treatment. JAAOS 2008; 16: 338-46. full article. review.
2) Riddle DL et al. Risk factors for plantar fasciitis: A matched case-control study. JBJS 2003; 85: 872-877. full article. risk factors bmi, work, and limit dorsiflex.
3) Harty J et al. The role of hamstring tightness in plantar fasciitis. Foot Ankle Int 2005; 26: 1089-92. full article. theory on etio.
4) Pfeffer G et al. Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciits. Foot Ankle Int 1999; 20: 214-21. full article. nonop recs.
5) Digiovanni BF et al. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. JBJS 2006; 88: 1775-81. full article. nonop recs.
6) Crawford F, Thomson C: Interventions for treating plantar heel pain.Cochrane Database Syst Rev 2003;