Plantar Fasciitis Flashcards
What is plantar fasciitis?
Inflammation of the plantar fascia of the foot.
It is usually unilateral (bilateral suggest systemic cause)
It is the most common cause of infracalcaneal pain
Epidemiology
10% prevalence
Most common between the ages of 40 -60 years old.
Explain the pathophysiology
Plantar fascia = thick fibrous band of connective tissue that goes from medial process of calcaneal tuberosity to the proximal phalanges.
Micro-tears to the plantar fascia breaks down the structure and causes inflammation.
Predisposition to plantar fasciitis.
Anatomical abnormality to the foot such a high medial longitudinal arch.
This leads to asymmetrical loading on the plantar fascia.
Risk factors
Anatomical factors like excessive pronation or high arches (pes cavus)
Weak plantar flexors
Prolonged standing or excessive running
Leg length discrepancy
Obesity
Unsupportive footwear
Clinical features
Sharp pain across the plantar aspect of the foot
Usually mostly felt on the heel and there it can be very severe
It radiates down the arch distally.
Usually worst with the first few steps of the day or after periods of inactivity and then it gets better.
Examination findings.
Infracalcaneal region is commonly tender on palpation and palpating the medial calcaneal tubercle can reproduce symptoms.
Assess for evidence of over-pronation
High arches
Leg length discrepancy
Femoral antervesion
Dx
Achilles tendonitis
Morton neuroma
Calcaneal stress fracture
Inflammatory arthropathy
Ix
Clinical diagnosis
If diagnosis is in doubt…
Plain X-ray to exclude bony injury and to assess for a plantar heel spur (50% of patients)
MRI scan can be done if there is uncertainty as well.
X-ray findings
In 50% of people you might see a plantar heel spur.
MRI findings
Can show areas of plantar fascial thickening and any associated oedema
Conservative management
Activity moderation
Regular analgesics (NSAIDs)
Adjusted footwear with a stury mid-sole and well-cushioned heel.
Orthotics to provide additional arch support if needed.
Physio.
Surgical management
Corticosteroid injections can be trialled if no improvement with conservative management.
If nothing provides improvement plantar fasciotomy can be done.
Explain plantar fasciotomy
Endoscopic procedure where part or all of the fascia is released.
75% success rate in reducing pain
Can lead to instability of the medial column of the foot.
Prognosis
Very good recovery usually with just conservative management
