Plantar Fasciitis

Description

• Degenerative change of plantar fascia at origin on medial tuberosity of calcaneus
• Classically presents as pain on plantar surface of the foot, usually at calcaneal insertion of plantar fascia with weight-bearing, especially in morning or on initiation of walking after prolonged rest
• Synonym(s): plantar fasciopathy, plantar heel pain syndrome, plantar fasciosis, and painful heel syndrome

Epidemiology

Incidence
Estimated 1 million patient visits yearly in the United States

Prevalence

• Most common cause of plantar heel pain
• Lifetime: 10–15% of population; peak incidence between ages 40 and 60 years; earlier in runners

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

• 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

• 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

• Heel spurs commonly seen but are not a marker of severity nor pathognomonic and surgical removal of unclear benefit
• Posterior tibial neuropathy