Plantar fasciitis is the inflammation of the plantar fascia which causes pain in the bottom of the heel. The plantar fascia is a thick, web like fascial structure ( band) that connects your heel to the front of your foot. It supports the arch of your foot and helps you walk.
Plantar fasciitis is one of the most common orthopedic complaints. The plantar fascia experience a lot of wear and tear in your daily life. Normally, this fascia act as shock absorbers, supporting the arch of the foot. Excessive pressure on your feet can damage or tear the plantar fascia and it becomes inflamed eventually the inflammation causes heel pain and stiffness.
EPIDEMIOLOGY AND CAUSES
10% of people in the United States may present with heel pain over the course of their lives, with 83% of these patients being active working adults between the ages of 25 and 65 years old. Two large national data sets of ambulatory care data from the Centers for Disease Control and Prevention’s National Center for Health Statistics found that plantar fasciitis accounts for an average of one million patient visits per year to medical doctors.
A recent survey of members of the American Podiatric Medical Association revealed that plantar fasciitis/heel pain was the most prevalent condition being treated in podiatric clinics. According to the current literature, prevalence rates of plantar fasciitis among a population of runners have been shown to be between 4% and 22%.
Increased body weight10 and increased body mass index (BMI) have been shown to be significant risk factors for plantar fasciitis, with a BMI of more than 30 kg/m2 having an odds ratio of 5.6 compared with a BMI of less than 25 kg/m2.
Plantar fasciitis is most commonly caused by repetitive strain injury to the ligament of the sole of the foot. Such strain injury can be from excessive running or walking, inadequate foot wear, and jumping injury from landing. Plantar fasciitis can also be caused by certain diseases, including Reactive arthritis and Ankylosing Spondylitis
RISK FACTORS INCLUDE
Plantar fasciitis is most common between the ages of 40 and 60.
Certain types of exercise.
Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballistic jumping activities etc can cause plantar fasciitis.
Being flat-footed, having a high arch or even having an abnormal pattern of walking can put additional stress on the plantar fascia.
Excess pounds put extra stress on your plantar fascia.
Occupations that keep you on your feet.
Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.
CLINICAL FEATURES AND PATHOPHYSIOLOGY
Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or rising from sitting. The pain is usually worse after exercise, not during it.
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.
Biomechanical dysfunction of the foot is the most common etiology of plantar fasciitis, however infectious, neoplastic, arthritic, neurologic, traumatic, and other systemic conditions can prove causative. The pathology is traditionally believed to be secondary to the development of microtrauma (microtears), with resulting damage at the calcaneal-fascial interface secondary to repetitive stressing of the arch with weight bearing.
Excessive stretching of the plantar fascia can result in microtrauma of this structure either along its course or where it inserts onto the medial calcaneal tuberosity. This microtrauma, if repetitive, can result in chronic degeneration of the plantar fascia fibers. The loading of the degenerative and healing tissue at the plantar fascia may cause significant plantar pain, particularly with the first few steps after sleep or other periods of inactivity.
PHYSICAL EXAMINATION AND DIAGNOSIS
Physical evaluation of plantar fasciitis is given below ( video link).
The pain of plantar fasciitis can usually be reproduced by palpating the plantar-medial calcaneal tubercle at the site of plantar fascial insertion to the heel bone.
In more severe cases, pain may be reproduced by palpation over the proximal portion of the plantar fascia.
A tight Achilles tendon is commonly a secondary finding and usually contributes to the pathology, ankle dorsiflexion may be limited as a result.
Other findings may include various deformities, skin changes, and flat-foot or pes planus foot type, overpronation, pes cavus or high-arched foot type, leg-length discrepancy, excessive lateral tibial torsion, and excessive femoral anteversion.
Other maneuvers that may reproduce the pain of plantar fasciitis include passive dorsiflexion of the toes, which is sometimes called the Windlass test, and having the patient stand on the tiptoes and toe-walk. In a study by De Garceau et al, having the patient bear weight during the windlass test increased the sensitivity of the test from 13.6% to 31.8%.
The Foot and Ankle Ability Measure is a good outcome measure to give to patients that are diagnosed with plantar fasciitis.
Ultrasound can help diagnose and confirm plantar fasciitis through the measurement of the plantar fascia thickness.
The most common treatments include stretching of the gastrocnemius/soleus/plantar fascia, orthotics, ultrasound, iontophoresis, night splints and joint mobilization or manipulation .
Stretching of plantar fascia
Manipulation for plantar fasciitis
Taping for plantar fasciitis
Rehabilitation Exercise for plantar fasciitis