Plantar Fasciitis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Plantar fasciitis is a common condition that involves inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes. It is one of the most common causes of heel pain.

Aetiology

Plantar fasciitis is caused by repetitive strain and stress on the plantar fascia. Factors that contribute to this condition include:

• Overuse from activities such as running, walking, or standing for long periods
• Obesity, which increases the load on the plantar fascia
• Foot structure issues, such as flat feet or high arches
• Improper footwear, particularly shoes with inadequate arch support or cushioning
• Age-related degeneration of the plantar fascia

Pathophysiology

The pathophysiology of plantar fasciitis involves:

• Microtears and inflammation within the plantar fascia due to repetitive stress
• Degeneration of the collagen fibres in the plantar fascia, leading to pain and stiffness
• Thickening of the plantar fascia over time, which can contribute to chronic pain

Risk Factors

• Middle-aged individuals (typically between the ages of 40-60)
• Obesity or sudden weight gain
• Prolonged standing or walking, particularly on hard surfaces
• Participation in high-impact sports such as running or dance
• Flat feet, high arches, or abnormal walking patterns
• Inappropriate footwear with poor arch support

Signs and Symptoms

The signs and symptoms of plantar fasciitis include:

• Sharp pain in the heel, particularly with the first steps in the morning or after prolonged periods of sitting
• Stiffness and discomfort in the arch of the foot
• Worsening pain with prolonged standing, walking, or running
• Pain that improves with rest but may return after periods of activity

Investigations

Specific investigations to diagnose plantar fasciitis include:

• Clinical examination: Assessment of heel pain and tenderness, particularly along the plantar fascia.
• Imaging studies:
  • Ultrasound: To assess thickening of the plantar fascia and detect inflammation.
  • X-rays: Typically used to rule out other conditions such as heel spurs or fractures.
  • MRI: In chronic or severe cases to evaluate the extent of tissue damage and rule out other pathologies.

Management

Primary Care Management

• Rest and activity modification: Reducing activities that exacerbate symptoms, particularly high-impact sports or prolonged standing.
• Pain management: Analgesics such as paracetamol or NSAIDs to relieve pain and inflammation.
• Ice application: Applying ice packs to the affected area to reduce swelling and pain.
• Footwear modification: Wearing shoes with proper arch support and cushioning.
• Orthotic devices: Custom or over-the-counter orthotics to support the arch and reduce strain on the plantar fascia.
• Stretching exercises: Regular stretching of the calf muscles and plantar fascia to improve flexibility and reduce tension.

Specialist Management

• Physiotherapy: Referral to a physiotherapist for a structured rehabilitation programme, including stretching and strengthening exercises.
• Corticosteroid injections: May be administered for severe pain that is not responsive to conservative measures.
• Shock wave therapy: Extracorporeal shock wave therapy (ESWT) may be used in chronic cases to promote healing.
• Surgical intervention: Rarely required, but may be considered in cases of persistent pain despite conservative treatment. Surgery may involve releasing part of the plantar fascia.

References

1. NHS (2024) Plantar Fasciitis. Available at: https://www.nhs.uk/conditions/plantar-fasciitis/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Plantar Fasciitis. Available at: https://cks.nice.org.uk/topics/plantar-fasciitis/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Plantar Fasciitis: Clinical Features, Diagnosis, and Management. Available at: https://www.bmj.com/content/350/bmj.h2909 (Accessed: 24 June 2024).
4. American Academy of Orthopaedic Surgeons (2024) Plantar Fasciitis. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/plantar-fasciitis/ (Accessed: 24 June 2024).

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