Plantar Fasciitis: Understanding Causes, Symptoms, and Treatment Options in Medicine

Plantar fascia is

-tough, fibrous fascial later that originates on calcaneus and inserts on proximal phalanges

What is the windlass effect

-extension of MTP joint stretches fascia

Plantar fasciitis (plantar heel pain)

-plantar heel pain arising from insertion of plantar fascia

-w/ or w/o bone spurs

what part of the heel is most commonly involved

-central

Is plantar fasciitis an inflammatory condition

-no, it's degenerative

What is the etiology of plantar fasciitis

-pathologic overload of plantar fascia at the calcaneal insertion

micro tears in fascia lead to

-perifascial edema and thickening of tissues

plantar fasciitis involves

-inflexibility and weakness of posterior structures

inflexibility and weakness of posterior structures + micro tears leads to

-decreased force absorption

What else is involved with plantar fasciitis

-collagen necrosis

-angiofibroblastic hyperplasia

-chondriod metaplasia

-matrix calcification

What are the risk factors for plantar fasciitis

-age (decreased shock absorption)

-increased BMI/body wt

-pronated foot

-decreased DF (compensatory pronation)

-occupational wt bearing

-new or sudden chngs in training

-firm footwear

What clinical findings will you see with plantar fasciitis

-pain w/ first step in the AM

-pain may be worse w/ wt bearing

-pain and tenderness to palpation over the medial calcaneal tubercle

-decreased DF

What is the bowstring test

-DF and evert foot

-extend great toe

-OR have pt stand in slight squat and extend great toe

how do you differentiate plantar fasciitis from fat pad atrophy

-no first step pain

-won't have pain hopping up and down on toes

how do you differentiate plantar fasciitis from calcaneal fx

-squeeze test of calcaneus

how do you differentiate plantar fasciitis from tarsal tunnel syndrome

-pain is along distribution of posterior tibial nn.

-inferior to med. malleolus

-not on plantar surface

general tx for ligamentous injuries

-in other quizlets

Tx for plantar fasciitis

-address pain (NSAIDS, modalities, self massage, night splint)

-correct or modify biomechanical factors related to overload (short achilles, decreased DF): orthotics, taping, heel cup, heel lift, footwear

-restore elasticity and flexibility of involved structures (STM, stretch, heat)

-strengthen active supports of arch (intrinsics, fib long, tib post)

-strengthen muscles up LE chain

-educate pt about training, risk factors assoc w/ BMI etc

-injections

-casting

-surgery

what cast do you use for plantar fasciitis

-walking cast positions foot for rest, reduction of pressure

-combined w/ night splints

what surgery can be done

-plantar fasciotomy (Rare)