Journal List > J Korean Foot Ankle Soc > v.20(3) > 1043419

Eun: The Diagnosis and Treatment of Plantar Fasciitis

Abstract

Plantar fasciitis is the most common cause of heel pain. The diagnosis of plantar fasciitis is primarily based on the presentation of symptoms and physical examination. Patients usually complain of heel pain at the medial calcaneal tubercle when taking their first step in the morning or when walking after resting. Diagnostic imaging is rarely required for the initial diagnosis of plantar fasciitis; however, it can be used for differential diagnosis. Conservative treatments, such as stretching, rest, ice massage, oral analgesics, foot orthotics, use of night splint, and corticosteroid injection, may be effective. The majority of patients report improvement with conservative treatments, and those who show no response from conservative treatments for a duration of six months or longer can consider extracorporeal shock wave therapy or surgery.

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Figure 1.
Image shows the plantar fascia attaching proximally to the medial calcaneal tubercle and extending distally into the base of the periosteum of the proximal phalanx of each toe and the metatarsal heads (A) and undergoing tension during the latter weight-bearing stage and, as the metatarsophalangeal joints undergo dorsiflexion, applying a tractional force at its point of insertion on the calcaneus (B). Revised from the article of Hicks (J Anat. 1954;88:25-30).4)
jkfas-20-93f1.tif
Figure 2.
Tenderness point of heel pain. (A) Sole of foot. (B) Medial aspect of foot. ① Heel pad atrophy. ② Plantar fasciitis. ③ Baxter nerve entrapment. ④ Calcaneal stress fracture. ⑤ Tarsal tunnel syndrome.
jkfas-20-93f2.tif
Figure 3.
Treatment algorithm for patients with plantar fasciitis.
jkfas-20-93f3.tif
Figure 4.
Plantar fascia-specific stretch is performed by dorsiflexing the toes with one hand and palpating the plantar fascia with the other hand to ensure that it is taut.
jkfas-20-93f4.tif
Figure 5.
Ice massage method, which involves rolling a frozen can under the foot.
jkfas-20-93f5.tif
Table 1.
Risk Factors for Plantar Fasciitis
Type Risk factor
Anatomic Obesity
Pes planus (flat feet)
Pes cavus (high-arched feet)
Shortened Achilles tendon
Biomechanic Overpronation (inward roll)
Limited ankle dorsiflexion
Weak intrinsic muscles of the foot
Weak plantar flexor muscles
Table 2.
Differential Diagnosis for Heel Pain
Type Diagnosis Common findings
Neurologic Tarsal tunnel syndrome: posterior tibial nerve impingement Burning sensation in the plantar region worsened by dorsiflexion
Neuropathy such as from diabetes Paresthesias in plantar region
Skeletal Acute calcaneal fracture Likely after hard landing on heel
Calcaneal stress fracture Most likely seen in runners
Sever disease: calcaneal apophysitis Seen in pediatric patients with open physes
Systemic arthritides such as rheumatoid Expect pain in multiple joints along with heel pain
Soft tissue Fat pad atrophy More common in elderly people
Fat pad contusion More likely associated with hard landing on heel
Achilles tendinitis Posterior calcaneal tenderness and tendon pain
Retrocalcaneal bursitis Pain in retrocalcaneal bursa
Posterior tibial tendinitis Pain along posterior tibial tendon and at insertion mid foot at the arch
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