Plantar fascitis

Asraf Amirullah
 Definition
Painful condition caused by inflammation if the plantar fascia
Felt at the sole of the foot
Usually while standing and worsen during get up in the
morning or getting down the staircase
Conditions usually comes gradually without clear incident or
injury
Sometimes after ptn exert sudden increase of physical
activity or change of foot wear or running surface
Also may have association with tightness off the Archilles
tendon
 Relevant anatomy
The os calcis is elevated anteriorly so
the during the heel strike, the posterior
tubercle contacts the ground 1st and
transmits full body weight.
This make the claceneum vulnerable to
trauma or micro trauma
The heel fat pad has many fat globules
enclosed by multiple fibroelastic septa.
Thise septa act like hydraulic chamber
to bear weight evenly across the os
class during locomotion
And after 40 years this fat pad begin to
atrophy and degenerate
 Relevant anatomy
The plantar
aponeurosis is an
inelastic fascia that
arises from to os
calcis and composed
of three segments
 Aetiology
Excessive pronation of the foot
Poor arch support in the shoe
Flat foot
Prolonged standing
Fat pad atrophy
Tight triceps surae
Repetitive strength imbalances
Stress, tension and pulling on the plantar fascia
 Aetiology
Overuse may cause micro tears and inflammation
Congenital problems such as Pescavus and
Pesplanus
Obesity
Reiters disease, Ankylosing spondylitis, diffuse
idiopathic skeletal hyperostosis
Some cause includes- excess running seven
walking uphill-Lack of stretching prior to
exercise- Wearing flexible , soft shoes that don’t
protect your feet- Injuries to the plantar fascia
 Pathology
Plantar fascia or aponeurosis is a dense structure that originate
from calceneum,deep to the heel fat pad and runs distally to
the ball of foot with slips to each toe
Plantar fascia will become stiffer and less pliable when
aging.At this time fascia isnt inflammed yet
Then by times when micro tears in fascia and fascia will
thickened
Fascia inflammed usually when there is association with
inflammatory disorder (example:Gout,ankylosing spondylitis
and Riters disease)
Clinical features
Localized tenderness
(Mostly at the medial aspec
and beneath the heels and
some to the midfoot)
If associate with
inflammatory
disease,swelling may
associate
 Clinical Features
Pain at the base of the heel
Pain is the most severe in the mornings on getting
out of bed, and the beginning of a run
Pain and tenderness at the bottom of foot
Pain described as burning, often sharp and can be
severe
Moving after any activity, such as sitting in a car or
at the desk
Sometimes associated with warmth and swelling of
the bottom of the foot
 Physical examination
This is good test to diagnose plantar fasciitis
Plantar fasciitis have more tenderness in plantar fascia
when it is stretch and less tender when fascia is relaxed.
To perform this test, first stretch the plantar fascia. Use
thumb or finger to feel the plantar fascia. If the plantar
fascia is tender, then try the same manoeuvre with the
plantar fascia is relaxed.
If pushing the stretched plantar fascia causes more
tenderness than pushing on relaxed plantar fascia, then
that is likely the sources of the pain and patient have
plantar fasciitis.
 Blood investigation
If association of other inflammatory condition
a. Gout-to take uric acid
b. Rheumatoid factor TRO seronegative
arthropathy
 Investigations
Xray
-Plain lateral ankle xray:help to exclude stress
fracture
-Usually often will show like a bone spur on
surface of calceneum
(Spur is a bony ridge that looks sharp )
 Investigations
MRI
- Show thickening of the plantar fascia
 Ultrasound
Thickening of planar fascia
Doppler shows increased local blood flow and
neovascularization

MRI
To exclude calceneal stress fracture
 Treatment
Rest
Cushion heels pad
NSAID (Orally or topically)
Stretching exercise and physiotherapy
-Regular stretching regime in 8-12weeks
Local Massage
Night splints (applied at night to keep foot up in plantigrade
position,prevent stiffening of Archilles and plantar fascites
Podiatric assessment for special footwear
- Botox: Diret analgesic and
Injection into plantar fascia
anti-inflammatory- Steroid
(Non convincing method and may cause rupture to plantar fascia )
 Operation
No definitive surgical approach
Plantar fascia and nerve release
Limited fasciotomy may help in some cases
but have significant risk of complications
including worsening of condition
 Modern interventions
Shockwave lithotripsy
Localized radiofrequency (Coblation) therapy

Both of these methods not fully tested with large

scale studies
 Modern interventions
Phonophoresis
Cryotherapy
Thank you