Plantar Fasciitis is a common musculoskeletal condition involving inflammation of the plantar fascia, the thick band of tissue connecting the heel bone to the toes.
🧍 Affects up to 10% of the population, a leading cause of heel pain, especially in athletes & those standing long hours.
⏳ Chronic untreated cases may increase the risk of long-term foot disability.

🧬 Aetiology

Plantar fasciitis arises from repetitive strain and overuse → microtears & inflammation at the fascial enthesis.

🔥 Inflamed Fascial Enthesis: Excessive stress causes chronic inflammation and degeneration.
🦴 Heel Spurs: May form due to tension, but not always painful.

🩺 Clinical Presentation

🦶 Heel Pain: Sharp, throbbing, worse on weight-bearing.
🌅 Morning Steps Pain: Severe with first steps after rest, eases as activity continues.
⬆️ Aggravation: Worse barefoot or on stairs.
🤲 Tenderness: Localized to medial calcaneum.
🔎 Bilateral Symptoms: Think systemic causes (e.g., spondyloarthropathy).

⚠️ Risk Factors

🎂 Age 40–60 yrs.
⚖️ Obesity.
👟 Prolonged standing jobs.
👣 Foot mechanics (flat feet, high arches).
👞 Poor footwear.
🏃 High-impact sports with repetitive movements.

🔍 Differential Diagnosis

🦵 Achilles tendinitis.
💧 Retrocalcaneal bursitis.
🩻 Stress fracture.
👦 Sever’s disease (children).
⚡ Peripheral neuropathy.

🧪 Investigations

🧑‍⚕️ Clinical exam: Tender heel, pain with dorsiflexion.
📷 Imaging:
- 🦴 X-ray → heel spur (not always significant).
- 📡 Ultrasound → fascia thickening & inflammation.
- 🧲 MRI → for atypical or refractory cases.
🚶 Gait analysis for biomechanical contributors.

💊 Management

Conservative:
- 🛌 Rest & activity modification.
- 👟 Heel pads / insoles for arch support.
- 🧘 Stretching plantar fascia & calf muscles.
- 🌙 Night splints to reduce morning pain.
- 👐 Physiotherapy (manual therapy, ultrasound, ice).
Pharmacological:
- 💊 NSAIDs for pain/inflammation.
- 💉 Steroid injections (short-term relief; avoid repeated use due to rupture risk).
Minimally Invasive:
- 🔊 Extracorporeal Shock Wave Therapy (ESWT).
Surgery (rare, refractory):
- 🔪 Endoscopic or open plantar fasciotomy.
Lifestyle:
- ⚖️ Weight management.
- 👞 Supportive footwear, avoid barefoot on hard floors.

📈 Prognosis

✅ Most cases resolve within 6–12 months with conservative care.
⏳ Chronic cases may take 3–5 years or require surgery.
🔄 Recurrence possible without preventive measures (weight, footwear, stretching).

📚 References

American Orthopaedic Foot & Ankle Society – Plantar Fasciitis
Mayo Clinic – Plantar Fasciitis
Keene JS, et al. J Am Acad Orthop Surg. 2004;12(7):468-476.
Rees J, et al. Foot Ankle Clin. 2016;21(3):425-438.

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