Plantar Fasciitis

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Clinically Relevant Anatomy

Plantar fascitis is a degenerative process that may or may not have inflammatory changes to the plantar fascia.  The plantar fascia originates on the medial tubercle of the calcaneous and fans out to the flextor tendon sheaths to form the longitudinal arch.  It's main purpose is to provide support and act as a shock absorber.

Mechanism of Injury / Pathological Process

The most common of injury is overuse such as running, jobs with prolonged standing, etc which allow for repetative micro trauma to the fascia.  B Young et al reported in 2004 that some other causes may include biomechanical derangements, inflammatory arthritis, stress fractures, and nerve.  According to the research, some common risk factors include obesity, an occupation with prolonged standing, heel spurs, pes planus, and decreased dorsiflexion.

Clinical Presentation

• Heel pain with first steps in the morning or after long periods of non-weight bearing
• Tenderness to the anterior medial heel
• limited dorsiflexion and tight achilles tendon
• a limp may be present or may have a preference to toe walking
• pain is usually worse when barefoot on hard surfaces and with stair climbing
• many patients may have had a sudden increase in their activity level prior to the onset of symptoms

Diagnostic Procedures

Currently there are no special tests or test item clusters for diagnosing plantar fascitis.  A diagnosis is generally made with regard to the symptoms present such as described above.  X-rays and ultrasonagraphy are also being used to help assess degenerative changes and x-rays help detect heel spurs which may or may not be present.  Ultrasonography is used to measure plantar fascia thickness, which is reported to be thicker in patients diagnosed with plantar fascitis according to a study by Wall. 

Outcome Measures

The FAAM, or Foot and Ankle Ability Measure, is a good outcome measure to give to patients that are diagnosed with plantar fascitis. 

Management / Interventions

The most common treatments include stretching of the gastroc/soleus/plantar fascia, orthotics, taping, ultrasound, shockwave therapy, iontophoresis, night splints, joint mobilization, and surgery.  According to a prospective, randomized controlled trial by DiGiovanni, stretching can be an appropriate treatment for plantar fascitis as long as it is specific stretching.  He compared patients who received general calf stretches compared with patients who received instructions on how to stretch the plantar fascia.  The results indicated that both groups improved but the group who received specific stretches improved to a greater degree.

Differential Diagnosis

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Key Evidence

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Resources

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