Plantar Fasciitis
Plantar fasciitis is a condition in which breakdown of the tissue of the plantar fascia (also known as the
plantar aponeurosis) and inflammation cause heel pain.
Symptoms:
•
Heel pain that is especially bad with the first few steps after a period of inactivity (such as
sleeping)
•
Pain then worsens throughout the day
Physical exam:
•
Tenderness at the origin of the plantar fascia, inferior calcaneus
Imaging:
•
X-rays may demonstrate inferior calcaneal osteophytes (heel spurs), but these are a result of
plantar fasciitis rather than the cause
•
MRI is only obtained if the diagnosis is in question (rule out stress fracture of the calcaneus) or if
surgery is being considered
Treatment (nonoperative):
•
Stretching exercises, especially before getting out of bed
•
Heel cups
•
Ice
•
Physical therapy
•
Footwear with good arch supports
•
Supportive footwear when getting out of bed rather than going barefoot
•
NSAIDs
•
Steroid injection
o
Risk of heel pad atrophy
o
Risk of rupture of plantar fascia
Treatment (surgical):
•
Uncommon (last resort)
•
Considered if no improvement after 6-12 months
•
Plantar fasciotomy (partial or complete)
•
Release of lateral plantar nerve branch may be performed
•
Excision of heel spurs does not appear to help