Makindo Medical Notes

Related Subjects: |Tennis Elbow |Golfer's Elbow |Painful Shoulder syndromes |Plantar fasciitis

👣 Bilateral plantar fasciitis may suggest underlying systemic conditions such as spondyloarthropathies.

📌 About Plantar Fasciitis

• 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.