Plantar Fasciitis Update & Current Best Practice
Background and History: Plantar Fasciitis (PF) is a common foot pathology accounting for 11-15% of all presenting foot pain disorders. PF is and overuse condition that results in inflammation and degeneration of the PF origin at the medial calcaneal tuberosity. Multiple factors can lead to PF including repetitive microtrauma from running, tightness of the gastrocnemius soleus and Achilles, high or low plantar arch. Patients complain of pain at the plantar heel which can be substantial. Pain is typically worse with first step out of bed and during weightbearing activities.
Exam: The hallmark is palpation tenderness at the medial plantar heel. Passive extension of the great toe can commonly increase pain. Assess for pes planus/cavus and calf tightness.
Imaging: X-rays may show a plantar spur, but this is not the cause of pain. About 50% of symptomatic and 20% of asymptomatic patients have heel spurs. However, many patients with PF have no heel spur. Ultrasound imaging will show thickening of the plantar fascia with decreased echogenicity.
Differential Diagnosis: Heel contusion, heel stress fracture, tarsal tunnel syndrome, fat pad atrophy.
Treatment: Physical therapy and custom orthotics to correct biomechanical issues will resolve most cases of PF. Steroid injections can provide temporary relief, however, they increase the risk of plantar fascia rupture and fat pad atrophy especially with repeat administration1. For resistant cases, PRP2 (platelet rich plasma) and Shock Wave Therapy3 are safe and effective treatment options. Very rarely is surgery indicated.
Shock Wave has been utilized in Europe for decades and has substantial data proving efficacy for soft tissue disorders such as PF, Achilles tendonitis, tennis elbow, trochanteric bursitis/gluteal tendonitis, calcific rotator cuff, etc. Shock Wave Therapy is now available in my office.
If I can help with any of your plantar fascia or foot pain issues, please come see me. As always, I’m available for NEXT DAY if not SAME DAY appointments for all urgent head-to-toe orthopedic issues.
References:
1. PMID: 19468912
2. PMID: 32426407
3. PMID: 18832341
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