[20] Plantar Fasciitis Flashcards
What is plantar fasciitis?
Inflammation of the plantar fascia of the foot
Is plantar fasciitis common?
Yes, estimated prevalence of 10%
Is plantar fasciitis unilateral or bilateral?
Can be either, but bilateral presentation suggests a systemic cause
Why is plantar fasciitis important?
Because it is the most common cause of infracalcaneal pain, and accounts for 80% of heel pain complaints
What age is plantar fasciitis most common at?
40-60
What is the plantar fascia?
A thick, fibrous band of connective tissue
What is the origin of the plantar fascia?
Medial process of the calcaneal tuberosity
Where does the plantar fascia extend?
Towards the forefoot
What is the insertion of the plantar fascia?
Each of the proximal phalanges
What is the current theory regarding the pathophysiology of plantar fasciitis?
Micro-tears to the plantar fascia occur, suggesting chronic breakdown of the structure rather than being solely due to the inflammatory process
What might cause predisposition to plantar fasciitis?
Anatomical structure of the foot
How can anatomical structure of the foot predispose to plantar fasciitis?
Any anatomical abnormality of the foot can result in asymmetric loading on the plantar fascia, leading to chronic repeated damage
What are the risk factors for plantar fasciitis?
Anatomical factors Weak plantar flexors or tight gastrocnemius or soleus Leg length discrepancy Obesity Unsupportive footwear
What anatomical factors increase the risk of plantar fasciitis?
Excessive pronation Pes cavus (high arches)
What are the symptoms of plantar fasciitis?
Patients will report a sharp pain across the plantar aspect of the foot
Where is the pain felt in plantar fasciitis?
Often felt most severely in the heel, and can radiate down the arch distall
When is the pain worse in plantar fasciitis?
Classically it tends to be worst with the first few steps of the day or after periods of inactivity, before easing off
What should be assessed on examination in plantar fasciitis?
Over-pronation
High arches
Leg length discrepancy
Femoral anteversion
What may be found on examination in plantar fasciitis?
The infracalcaneal region is commonly tendon on palpation, and palpating the medial calcaneal tubercle can reproduce the symptoms
What are the important differential diagnoses in plantar fasciitis?
Achilles tendonitis
Morton neuroma
Calcaneal stress fracture
Inflammatory arthropathy
What is the role of investigations in the diagnosis of plantar fasciitis?
Plantar fasciitis is a clinical diagnosis, hence further investigations are only performed if the diagnosis is in doubt
What investigations may be done in plantar fasciitis?
Plain radiographs
MRI scan
What is the purpose of plain radiographs in plantar fasciitis?
To exclude bony injury
Assess for plantar heel spur
When will a plain radiograph be required to rule out trauma in plantar fasciitis?
If there is a history of trauma
What % of patients with symptomatic plantar fasciitis will have a heel spur on radiograph?
About 50%
What does the presence of a plantar heel spur indicate?
Abnormal loading of the plantar fascia
When is an MRI scan indicated in plantar fasciitis?
If there is ongoing uncertainty of the diagnosis
What can a MRI scan identify in plantar fasciitis?
Areas of plantar thickening
Any associated oedema
What forms the mainstay of management for plantar fasciitis?
Activity moderation
Regular analgesics
What analgesics are typically used in plantar fasciitis?
NSAIDs
What changes can be made to footwear in plantar fasciitis?
Providing shoe with well-cushioned heel and sturdy mid-sole
What can orthotics provide in plantar fasciitis?
Additional arch support where required
When might physiotherapy be useful in plantar fasciitis?
If the underlying cause is muscle tightness or imbalance
What can be provided in physiotherapy for plantar fasciitis?
A stretching programme
What does the stretching programme in plantar fasciitis often focus on?
Calf stretches
Passive extension of the toes
What effect does strengthening the intrinsic muscles of the foot have in plantar fasciitis?
Provides symptomatic relief
What can be trialled if there is no improvement with initial conservative management in plantar fasciitis?
Corticosteroid injections
What is the advantage of corticosteroid injections in plantar fasciitis?
It can have good temporary effects
What is the disadvantage of corticosteroid injections in plantar fasciitis?
It does not always resolve the problem long term
What surgical option can be considered in plantar fasciitis?
Plantar fasciotomy
How is a plantar fasciotomy performed?
It is an endoscopic procedure, whereby part or all of the fascia is released
What is the success rate of plantar fasciotomy in reducing pain?
Around 75%
What is the disadvantage of a plantar fasciotomy?
It can result in some instability of the medial column of the foot
What is the prognosis of plantar fasciitis?
Very good
Why is the prognosis of plantar fasciitis very good?
As symptoms usually resolve following conservative management techniques
