PLANTAR FASCIITIS

Patho-physiology

Repeated tensile and compressional stresses on the arched foot

Fascial anatomy focusing stress into narrow band of fibrocartilage

Cycles of tearing and healing Release of chemical mediators

of inflammation, producing pain Eventually, myxoid

degeneration and weakening of the fascia

A pronated, flat foot and rarely a spontaneous rupture

Painful scar tissue and calcification (spur formation)

Risk Factors

Overweight Middle-aged Sedentary lifestyle Reduced ankle dorsiflexion1 Hard surfaces Flat shoes Human leucocyte antigen (HLA) B27 associated

spondyloarthropathies

Presentation

Pain BELOW the heel - ‘tearing’

above heel→ usually Achilles tendonitis

dorsiflexion of toes and ankle causes

radiates to forefoot/leg→ S1/S2 lesion

pain- worst in morning- on weight-bearing

Tenderness maximal at origin of fascia

Dorsiflexion of toes and ankle causes pain

TREATMENT ALGORITHMbased on severity of symptoms and order to try

Mild (all easy to achieve in primary care) • Education • Insoles • Passive stretching exercises • Ice and heat • Cross-frictional massage • Non-steroidal anti-inflammatory steroids (NSAIDs)

Moderate (may need referral, depending on local resources/expertise) • All the above measures • Physiotherapy • Steroid/local anaesthetic injection • Rigid night splint • Removable walking brace

Severe/failure to respond (referral to secondary care recommended) • Reassess diagnosis – REFER • Surgery?

Treatment of Plantar FasciitisTreatment of Plantar Fasciitis

The Slant-board Stretch & the Stair stretch

Treatment of Plantar FasciitisTreatment of Plantar Fasciitis

Dynamic stretches such as rolling the foot arch over a can or a tennis balls are also useful. Cross-friction massage above the plantar fascia and towel stretching may be done before getting out of bed.

SplintingSplinting

Some other treatments available are supports Some other treatments available are supports such as night splints which stretch the plantar such as night splints which stretch the plantar fascia while you sleep. By stretching the plantar fascia while you sleep. By stretching the plantar fascia, it will be forced to lengthen and avoid the fascia, it will be forced to lengthen and avoid the early morning tightness and pain brought on by early morning tightness and pain brought on by lack of use overnight while at rest.lack of use overnight while at rest.

Tension Night Splint

Plantar Fascia Injection

Don’t Forget Unusual Things

Pain after 3-6 months not responding to treatment→ Fibrosarcoma Foreign body Paget’s TB Gout