- Degenerative change of plantar fascia at origin on medial tuberosity of calcaneus
- Pain on plantar surface, usually at calcaneal insertion of plantar fascia on weight bearing, especially in morning or on initiation of walking after prolonged rest
- Synonym(s): plantar fasciopathy, plantar heel pain syndrome, plantar fasciosis, painful heel syndrome
Estimated 1 million patient visits yearly in the United States
- Most common cause of plantar heel pain
- Lifetime: 10–15% of population
- Peak incidence between ages 40 and 60 years, earlier peak in runners
Etiology and Pathophysiology
- 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
- 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
- Dancers, runners, court-sport athletes
- Occupations with prolonged standing, especially on hard surfaces (nurses, letter carriers, warehouse/factory workers)
- Overuse and rapid increase in activities involving repetitive loading
- 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
- Usually isolated
- Heel spurs commonly seen but are not a marker of severity nor pathognomonic and surgical removal of unclear benefit
- Posterior tibial neuropathy
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