Plantar Fasciitis
BASICS
BASICS

BASICS
DESCRIPTION
DESCRIPTION
DESCRIPTION
- Degenerative change of plantar fascia at origin on medial tuberosity of calcaneus
- Classically presents as pain on plantar surface of foot, usually at calcaneal insertion of plantar fascia, with weight-bearing especially in morning or on initiation of walking after prolonged rest
- Also referred to as plantar fasciopathy, plantar heel pain syndrome, plantar fasciosis, painful heel syndrome
EPIDEMIOLOGY
EPIDEMIOLOGY
EPIDEMIOLOGY
Incidence
Incidence
Incidence
Estimated 1 million patient visits yearly in the United States
Prevalence
Prevalence
Prevalence
- Most common cause of plantar heel pain
- Lifetime: 10–15% of population; peak incidence between 40 and 60 years, earlier in runners
ETIOLOGY AND PATHOPHYSIOLOGY
ETIOLOGY AND PATHOPHYSIOLOGY
ETIOLOGY AND PATHOPHYSIOLOGY
- Plantar fascia is composed of fibrous and dense connective tissue.
- Three bands: medial, lateral, and central
- Supports longitudinal plantar arch, assists intrinsic foot musculature, may assist in energy storage
- Repetitive microtrauma and collagen degeneration of plantar fascia
- Chronic degenerative change (-osis/-opathy rather than -itis) of plantar fascia generally at insertion on medial tuberosity of calcaneus
RISK FACTORS
RISK FACTORS
RISK FACTORS
- Intrinsic
- Age (40 to 60 years)
- Female, pregnancy
- Obesity (BMI >30 kg/m2)
- Pes planus (flat feet), pes cavus (high arch), overpronation, leg length discrepancy
- Hamstring, calf, and Achilles tightness
- Calf and intrinsic foot muscle weakness
- Decreased ankle range of motion with dorsiflexion (equinus or tight heel cord; <15 degrees of dorsiflexion)
- Systemic connective tissue disorders
- Extrinsic
- Dancers, runners, court sport athletes (e.g., tennis, volleyball)
- Occupations with prolonged standing, especially on hard surfaces (nurses, letter carriers, warehouse/factory workers)
- Overuse and rapid increase in activities involving repetitive loading
GENERAL PREVENTION
GENERAL PREVENTION
GENERAL PREVENTION
- Maintain normal body weight.
- Avoid training errors (increasing intensity, distance, duration, and frequency of high-impact activities too rapidly); avoid overtraining.
- Proper footwear (appropriate cushion/arch support)
- Runners should replace footwear every 250 to 500 miles.
COMMONLY ASSOCIATED CONDITIONS
COMMONLY ASSOCIATED CONDITIONS
COMMONLY ASSOCIATED CONDITIONS
- Heel spurs commonly seen, but are not a marker of severity nor pathognomonic; surgical removal of unclear benefit
- Posterior tibial neuropathy
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