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A - MSRA MSK [11] > [20] Plantar Fasciitis > Flashcards

[20] Plantar Fasciitis Flashcards

1
Q

What is plantar fasciitis?

A

Inflammation of the plantar fascia of the foot

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2
Q

Is plantar fasciitis common?

A

Yes, estimated prevalence of 10%

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3
Q

Is plantar fasciitis unilateral or bilateral?

A

Can be either, but bilateral presentation suggests a systemic cause

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4
Q

Why is plantar fasciitis important?

A

Because it is the most common cause of infracalcaneal pain, and accounts for 80% of heel pain complaints

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5
Q

What age is plantar fasciitis most common at?

A

40-60

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6
Q

What is the plantar fascia?

A

A thick, fibrous band of connective tissue

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7
Q

What is the origin of the plantar fascia?

A

Medial process of the calcaneal tuberosity

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8
Q

Where does the plantar fascia extend?

A

Towards the forefoot

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9
Q

What is the insertion of the plantar fascia?

A

Each of the proximal phalanges

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10
Q

What is the current theory regarding the pathophysiology of plantar fasciitis?

A

Micro-tears to the plantar fascia occur, suggesting chronic breakdown of the structure rather than being solely due to the inflammatory process

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11
Q

What might cause predisposition to plantar fasciitis?

A

Anatomical structure of the foot

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12
Q

How can anatomical structure of the foot predispose to plantar fasciitis?

A

Any anatomical abnormality of the foot can result in asymmetric loading on the plantar fascia, leading to chronic repeated damage

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13
Q

What are the risk factors for plantar fasciitis?

A 
Anatomical factors
Weak plantar flexors or tight gastrocnemius or soleus
Leg length discrepancy
Obesity
Unsupportive footwear
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14
Q

What anatomical factors increase the risk of plantar fasciitis?

A 
Excessive pronation
Pes cavus (high arches)
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15
Q

What are the symptoms of plantar fasciitis?

A

Patients will report a sharp pain across the plantar aspect of the foot

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16
Q

Where is the pain felt in plantar fasciitis?

A

Often felt most severely in the heel, and can radiate down the arch distall

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17
Q

When is the pain worse in plantar fasciitis?

A

Classically it tends to be worst with the first few steps of the day or after periods of inactivity, before easing off

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18
Q

What should be assessed on examination in plantar fasciitis?

A

Over-pronation
High arches
Leg length discrepancy
Femoral anteversion

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19
Q

What may be found on examination in plantar fasciitis?

A

The infracalcaneal region is commonly tendon on palpation, and palpating the medial calcaneal tubercle can reproduce the symptoms

20
Q

What are the important differential diagnoses in plantar fasciitis?

A

Achilles tendonitis
Morton neuroma
Calcaneal stress fracture
Inflammatory arthropathy

21
Q

What is the role of investigations in the diagnosis of plantar fasciitis?

A

Plantar fasciitis is a clinical diagnosis, hence further investigations are only performed if the diagnosis is in doubt

22
Q

What investigations may be done in plantar fasciitis?

A

Plain radiographs

MRI scan

23
Q

What is the purpose of plain radiographs in plantar fasciitis?

A

To exclude bony injury

Assess for plantar heel spur

24
Q

When will a plain radiograph be required to rule out trauma in plantar fasciitis?

A

If there is a history of trauma

25
Q

What % of patients with symptomatic plantar fasciitis will have a heel spur on radiograph?

A

About 50%

26
Q

What does the presence of a plantar heel spur indicate?

A

Abnormal loading of the plantar fascia

27
Q

When is an MRI scan indicated in plantar fasciitis?

A

If there is ongoing uncertainty of the diagnosis

28
Q

What can a MRI scan identify in plantar fasciitis?

A

Areas of plantar thickening

Any associated oedema

29
Q

What forms the mainstay of management for plantar fasciitis?

A

Activity moderation

Regular analgesics

30
Q

What analgesics are typically used in plantar fasciitis?

A

NSAIDs

31
Q

What changes can be made to footwear in plantar fasciitis?

A

Providing shoe with well-cushioned heel and sturdy mid-sole

32
Q

What can orthotics provide in plantar fasciitis?

A

Additional arch support where required

33
Q

When might physiotherapy be useful in plantar fasciitis?

A

If the underlying cause is muscle tightness or imbalance

34
Q

What can be provided in physiotherapy for plantar fasciitis?

A

A stretching programme

35
Q

What does the stretching programme in plantar fasciitis often focus on?

A

Calf stretches

Passive extension of the toes

36
Q

What effect does strengthening the intrinsic muscles of the foot have in plantar fasciitis?

A

Provides symptomatic relief

37
Q

What can be trialled if there is no improvement with initial conservative management in plantar fasciitis?

A

Corticosteroid injections

38
Q

What is the advantage of corticosteroid injections in plantar fasciitis?

A

It can have good temporary effects

39
Q

What is the disadvantage of corticosteroid injections in plantar fasciitis?

A

It does not always resolve the problem long term

40
Q

What surgical option can be considered in plantar fasciitis?

A

Plantar fasciotomy

41
Q

How is a plantar fasciotomy performed?

A

It is an endoscopic procedure, whereby part or all of the fascia is released

42
Q

What is the success rate of plantar fasciotomy in reducing pain?

A

Around 75%

43
Q

What is the disadvantage of a plantar fasciotomy?

A

It can result in some instability of the medial column of the foot

44
Q

What is the prognosis of plantar fasciitis?

A

Very good

45
Q

Why is the prognosis of plantar fasciitis very good?

A

As symptoms usually resolve following conservative management techniques

A - MSRA MSK [11] (38 decks)

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