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Updated: Dec 28 2021

Plantar Fasciitis

Images fasciitis1.jpg fasciitis xray.jpg
  • Snapshot
    • A 45-year-old woman presents to the physician’s office for foot pain. She reports that this pain has been going on for 6 months now. The pain is worse in the morning or after a nap and improves with walking. As a marathon runner, she is worried that her daily running has caused this condition. She is counseled and reassured that no surgery is needed.
  • Introduction
    • Clinical definition
      • degenerative condition of the plantar fascia that causes sharp pain on the bottom of the foot pain
  • Epidemiology
    • Demographics
      • female > male
      • 40-60 years of age
      • older and obese patients
    • Location
      • plantar fascia originates at the calcaneal tubercle
    • Risk factors
      • obesity
      • flat feet (pes planus)
      • overpronation of the foot
      • prolonged walking or running
  • Etiology
    • May be due to bony spur but often the etiology is unknown
    • Pathogenesis
      • repetitive microtrauma from prolonged use of foot causes tensile overload and damage to the plantar fascia
    • Associated conditions
      • Achilles tendinopathy
  • Presentation
    • Symptoms
      • sharp heel pain, like a tack in the foot
        • pain is worse with first step in the morning or after a period of rest, then improves with walking
        • may be worse again at the end of the day with prolonged weight-bearing
        • may also improve with stretching, massage, and rest
    • Physical exam
      • tenderness to palpation at the underside of the heel, at the insertion of the plantar fascia
      • positive windlass test
        • pain elicited when the clinician dorsiflexes the hallux and stretches the plantar fascia
  • Imaging
    • Radiography
      • indication
        • typically not indicated unless the diagnosis is unclear
      • findings
        • may have a bony spur at the location of the pain
  • Differential
    • Tarsal tunnel syndrome
      • distinguishing factors
        • presents with pain or numbness along the plantar surface of the foot that is worsened by tapping the tarsal tunnel
        • in comparison with plantar fasciitis, pain does not get better with rest and rather may be the worst at night
    • Making the diagnosis
      • most cases are clinically diagnosed
  • Treatment
    • Conservative
      • stretching of the foot and calf
        • indication
          • for all patients
      • orthotics or night splinting
        • indication
          • for all patients
    • Medical
      • nonsteroidal anti-inflammatory drugs (NSAIDs)
        • indication
          • pain management
      • steroid injection
        • indication
          • pain management refractory to NSAIDs
  • Complications
    • None
  • Prognosis
    • Typically resolves spontaneously in 1-2 years
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