Prof. dr.

Widiastuti Samekto, PAK,

SpS(K), MSc.
Human foot is a complex unit
It consists of 26 bones:
14 phalanges
5 metatarsals
7 tarsals
Can be divided into 3
functional segments:
Hindfoot
Midfoot
Forefoot



The bones are stabilized by the ligaments
There are extrinsic muscles and intrinsic
muscles
Those that the origin is away from the foot called
extrinsic foot muscles
Whereas those that originate and insert within the
foot called intrinsic foot muscles
E
x
t
r
i
n
s
i
c

m
u
s
c
l
e
s

Gastrocnemius
Soleus
Tibialis anterior,
Tibialis posterior,
Peroneus longus,
Peroneus brevis,
Ekstensor hallucis
longus,
Ekstensor digitorum
longus,
Fleksor hallucis
longus,
Fleksor digitorum
longus.




I
n
t
r
i
n
s
i
c

m
u
s
c
l
e
s

1
st
layer
Abductor digiti quinti
Abductor hallucis
Fleksor digitorum brevis.
2
nd
layer
Quadrates plantae,
Lumbricales
Fleksor digitorum longus.
3
rd
layer
Abductor hallucis,
transverse head
Abductor hallucis, oblique
head
Fleksor hallucis brevis,
Fleksor digiti quinti brevis.
4
th
layer
Interosseus plantaris,
Interosseus dorsalis.

Plantar fascia is a
continuation of the plantaris
tendon

Its origin is upon the medial
tubercle of the calcaneus
then splits into five bands to
attach to each digit
Plantar fascia is a thick
fibrous band of tissue
that runs along the
bottom of the foot.

This tissue connects the
heel to the base of the
toes and stretched
with every step
Plantar fascia acts as a
shock-absorbing
bowstring within the
arc of the foot.

Plantar fasciitis is
inflammation of the thick
fibrous band of tissue
(plantar fascia) that runs
along the bottom of the
foot.

About 2 million people in
US seek for medical
treatment because of
plantar fasciitis annually
Plantar fasciitis is presented by a sharp
stabbing pain at the bottom or front of the
heel bone.

The pain of plantar fasciitis is usually
located close to where the fascia attaches
to the calcaneous, also known as the heel
bone.
Pain is often most intense
with your first steps when
getting out of bed in the
morning.

Heel pain is more severe
following periods of inactivity
(resting or sleeping) when
getting up and then subsides,
turning into a dull ache.

Abnormalities of
plantar anatomy: flat
foot, high arches
Overload physical
activities or exercises

Wearing incorrect
shoes

Overweight

Plantar
Fasciitis
Tear and
Inflammation
of the Plantar
Fascia
Spur

Age

Plantar fasciitis is also
influenced by the
mechanics of the foot.

Having conditions such as
flat feet, high arches feet
made the fascia tissue
become overworked or
stretched abnormally,
resulting in tears and
inflammation.
Shoes that are too worn, thin-
soled, loose, lack arch
support or lack shock
absorption provide
inadequate protection of the
foot

Frequent use of high heeled
shoes shortens the Achilles
tendon which stresses the
plantar fascia
Activity in sports and regular exercises can
place significant stress on the heel and
surrounding tissue.

Overload tear of the fascia
Plantar Fasciitis
Weight plays a huge role in
damage to the heel.

Since our heels absorb much of
our body's pressure when we
walk, being overweight can easily
lead to damage and plantar
fasciitis.

Pregnancy can also add a few
extra pounds. However, the
hormonal changes in pregnant
women can also cause ligaments
and other tissue to relax and
become more pliable could
lead to plantar fasciitis
Age also plays a factor.

As we age, tissue tends to
become weaker and more
prone to damage.
A bony prominence or
spur may develop at the
attachment of the plantar
fascia to the calcaneus.

Spur is an ossification and
calcification resulting from
traction of the plantar
fascia upon the periosteum
and occur commonly
without pain.
A spur is probably a coincidental finding as
they are often found in asymptomatic feet
and often not found in patient with
symptom
Mortons Neuroma
Sesamoiditis


The characteristic pain on dorsiflexion of the toes
associated with plantar fasciitis should help
distinguish these painful condition of the foot.
Resting
: prolonged and continued irritation can
delay the healing process

Stretching and Strengthening Exercises
: muscles and tendon stretching and also
strengthening of the intrinsic muscles can improve
biomechanics of the foot and reduce stress
Pain and Inflammation management
Ice cube massage 2-3 times/day for 5 min
Anti inflammation and analgetics
Surgical treatment if necessary, e.g. plantar
fasciitis because of spur
Improve foot biomechanics
Use of well fitting, appropriate shoes
Night splint






Site Syringe Needle Anesthetic Corticosteroid
Hydrocortis
one
equivalents
per
injection
(mg)
Plantar
fascia
5 mL 25 gauge,
1.5 inch
2 mL of 1%
lidocaine
(Xylocaine) or
0.25% or 0.5%
bupivacaine
(Marcaine)
1 mL of Celestone* 150
or
1 mL of 40 mg per mL of
methylprednisolone
(Solumedrol)
200
The patient is placed in the lateral recumbent
position with the affected side down.
The physician identifies the medial aspect of
the foot and palpates the soft tissue just distal
to the calcaneus, locating the point of
maximal tenderness or swelling.
The needle should be inserted directly down
past the midline of the width of the foot.
The physician should avoid injecting through
the base of the foot, because this approach
can result in the complications of
pharmaceutical leakage and fat pad atrophy.

The patient should remain in the supine position
for several minutes after the injection.
The patient should remain in the office for 30
minutes after the injection to be monitored for
adverse reactions.
In general, patients should avoid any strenuous
activity involving the injected region for at least 48
hours.
Patients should be cautioned that they may
experience worsening symptoms during the first 24
to 48 hours. This is related to a possible steroid
flair, which can be treated with ice and NSAIDs
(e.g., ibuprofen, naproxen). A follow-up
examination within three weeks should be
arranged