Definition
Plantar fasciitis is an inflammation of the aponeurosis at its origin on the calcaneus, usually secondary to chronic overuse or repetitive trauma.
It affects men and women equally
Risk factors
Obesity (high BMI)
Decreased ankle dorsiflexion in a non-athletic population (tightness of the foot and calf musculature)
weight bearing endurance activity (dancing, running)
Symptoms
insidious onset of heel pain, often when first getting out of bed . Patients may prefer to walk on toes initially, and then relieved by ambulation. Pain is worse at the end of the day after prolonged standing.
Common to have symptoms bilaterally
Associated conditions
calcaneal apophysitis
gastrocnemius-soleus contracture
heel pain triad (plantar fasciitis. posterior tibial tendon dysfunction, tarsal tunnel syndrome)
anatomic variations: femoral anteversion, pes cavus
pes planus
Treatment
Conservative Treatment
Pain management, splinting, physical therapy ( including achilles)
Cortisone injections (can lead to fat pad atrophy or plantar fascia rupture)
Shock wave treatment : second line of treatment. Used for chronic heel pain lasting longer than 6 months when other treatments have failed
Surgical release with plantar fasciotomy
Can be done open or arthroscopically. (open procedure is indicated if tarsal tunnel syndrome is present as well)
Release medial one-third to two-thirds: avoid complete release as it may lead to
destabilization of the longitudinal arch
overload of the lateral column
dorsolateral foot pain
Complications
Lateral plantar nerve injury
Complete release of the plantar fascia with destabilization of medial longitudinal arch
Increased stress on the dorsolateral midfoot
Chronic pain
Plantar fascia rupture