Plantar Fasciitis

Description:

o Microtrauma to plantar fascia near its attachments leading to attempted repair and chronic inflammation

o The most common cause of heel pain

o May be associated with a calcaneal spur

o No clear single etiology for pain

o No single treatment

o Common in runners and dancers

Plantar Fascia	Calcaneal bone spur

Symptoms:

o Calcaneodynia (heel pain)

o “First step pain” in morning

o Pain along plantar, medial aspect of heel

o Pain may extend distally toward metatarsal heads

o Pain worsens with dorsiflexion of toes

Treatment:

o Conservative, nonsurgical is the mainstay of treatment, including:

o Heel cord stretching regimen

o Anti-inflammatory medications

o Heel cushioning

o Orthotic insert under longitudinal arch of foot if flat foot present

o Corticosteroid injection (right)

o Night splint to maintain neutral position of ankle to prevent Achilles tendon shortenong overnight

o Absolute rest - casting

o Over 80% of patients respond to conservative management

Surgical therapy:

o If no improvement after 1 year of conservative treatment:

o Excision of plantar heel spur,

if present

o Release of plantar fascia