Plantar Fasciitis

BASICS

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

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 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; surgical removal of unclear benefit
  • Posterior tibial neuropathy

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