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Plantar fasciitis (PF), also known as Plantar Heel Pain (PHP) is a painful inflammatory process of the plantar fascia, the connective tissue or ligament on the sole (bottom surface) of the foot. It is often caused by overuse of the plantar fascia, increases in activities, weight or age. It is a very common condition and can be difficult to treat if not looked after properly.
Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis. The suffix "osis" implies a pathology of chronic degeneration without inflammation. Since tendons and ligaments do not contain blood vessels, they do not actually become inflamed. Instead, injury to the tendon is usually the result of an accumulation over time of microscopic tears at the cellular level.
The plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. It has been reported that plantar fasciitis occurs in two million Americans a year and in 10% of the U.S. population over a lifetime. It is commonly associated with long periods of weight bearing and much more prevalent with hyper-pronation (flat feet). Among non-athletic populations, it is associated with a high body mass index. The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is an increased probability of knee pains, especially among runners.
The diagnosis of plantar fasciitis is usually made by clinical examination alone. The clinical examination may include checking the patient’s feet and watching the patient stand and walk. The clinical examination will take under consideration a patient's medical history, physical activity, foot pain symptoms and more. The doctor may decide to use imaging studies like radiographs (X-rays), diagnostic ultrasound and MRI.
An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus heel bone, in which case it is the underlying plantar fasciitis that produces the pain, and not the spur itself. The condition is responsible for the creation of the spur; the plantar fasciitis is not caused by the spur.
Sometimes ball-of-foot pain is mistakenly assumed to be derived from plantar fasciitis. A dull pain or numbness in the metatarsal region of the foot could instead be metatarsalgia, also called capsulitis. Some current studies suggest that plantar fasciitis is not actually inflamed plantar fascia, but merely an inflamed flexor digitorum brevis muscle (FDB) belly. Ultrasound evidence illustrates fluid within the FDB muscle belly, not the plantar fascia.
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Treatment options for plantar fasciitis include rest, Microcurrent electrical neuromuscular stimulator treatment, massage therapy, stretching, night splints, physical therapy, cold therapy, heat therapy, orthotics, anti-inflammatory medications, injection of corticosteroids and surgery in refractory cases.
Based on current research, recommendations for immediate relief and reduction of inflammation include heel and foot stretching exercises as can be tolerated, microcurrent treatment, rest, wearing shoes with good support and cushions. Other steps to relieve pain include: applying ice or ice-heat-ice, and/or using night splints to stretch the injured fascia. Customized functional foot orthotics can offer a decrease in the pain associated with plantar fasciitis and may provide an additional benefit in terms of increased functional ability in patients with the condition. According to a clinical practice guideline, "there is no evidence" to support the use of foot orthotics for long-term (1 year) pain management or function improvement.
Some evidence shows that stretching of the calf and plantar fascia may provide up to 2–4 months of benefit. One study has shown improvement over a four-month period with stretching. One study has shown high success rates with a stretch of the plantar fascia, but has been criticized because it was not blinded, and contained a bias because the analysis did not use the intention to treat method. Because it is impractical to do double-blind experiments involving stretching, such studies are vulnerable to placebo effects.
Pain with the first steps of the day can be markedly reduced by stretching the plantar fascia and Achilles tendon before getting out of bed. Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease pain on waking. These have many different designs. The type of splint has not been shown to affect outcomes.
To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of limited benefit. Dexamethasone 0.4 % or acetic acid 5% delivered by iontophoresis combined with low Dye strapping and calf stretching has been shown to provide short term pain relief and increased function.
Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, especially if not combined with a local anesthetic and injected slowly with a small-diameter needle. Recurrence rates may be lower if injection is performed under ultrasound guidance. Repeated steroid injections may result in rupture of the plantar fascia.
Surgery carries the risk of nerve injury, infection, rupture of the plantar fascia, and failure to improve the pain. This allows more space for the inflamed muscle belly, thus, relieving pain/pressure. An ultrasound-guided needle fasciotomy can be used as a minimally invasive surgical intervention for plantar fasciitis. A needle is inserted into the plantar fascia and moved back and forwards to disrupt the fibrous tissue.
Coblation surgery (aka Topaz procedure) has been used successfully in the treatment of recalcitrant plantar fasciitis. This procedure utilizes radiofrequency ablation and is a minimally invasive procedure.
Extracorporeal shockwave therapy
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There is contradictory evidence and recommendations for the efficacy of extracorporeal shockwave therapy (ESWT), or the use of acoustic shock waves, as treatment for plantar fasciitis. One review found that the preponderance of evidence supports the use of ESWT, but only after several months of treatment with more accepted and proven therapies have failed, as a possible alternative to surgical intervention. However, other reviews, including one in the New England Journal of Medicine and a meta-analysis of randomized controlled studies, found that the evidence does not support its use in the treatment of plantar fasciitis, with the highest quality studies (with the least likelihood of bias) showing no evidence of efficacy. A meta-analysis published in 2002 found that shockwave therapy was an effective treatment for plantar fasciitis that has failed to respond to other non-surgical treatments. The American Academy of Orthopaedic Surgeons notes that ESWT is sometimes tried before surgery due to minimal risk involved, but due to lack of consistent results it is not commonly performed.
- Flat feet
- Plantar calcaneal bursitis (Policeman's foot) inflammation of the Plantar calcaneal bursa, characterized by marked swelling and tenderness at central plantar heel area.
- Lemont, H.; Ammirati, K. M.; Usen, N. (2003). "Plantar fasciitis: A degenerative process (fasciosis) without inflammation". Journal of the American Podiatric Medical Association 93 (3): 234–237. PMID 12756315.
- Riddle, D. L.; Pulisic, M.; Pidcoe, P.; Johnson, R. E. (2003). "Risk factors for Plantar fasciitis: A matched case-control study". The Journal of bone and joint surgery. American volume 85–A (5): 872–877. PMID 12728038.
- McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ (2008). "Heel Pain – Plantar Fasciitis" (PDF). J Orthop Sports Phys Ther. 38 (4): A1–A18. doi:10.2519/jospt.2008.0302. PMID 18434670. Retrieved 2011-06-21.
- Buchbinder, R. (2004). "Plantar Fasciitis". New England Journal of Medicine 350 (21): 2159–2166. doi:10.1056/NEJMcp032745. PMID 15152061.
- Cole, C.; Seto, C.; Gazewood, J. (2005). "Plantar fasciitis: Evidence-based review of diagnosis and therapy". American family physician 72 (11): 2237–2242. PMID 16342847.
- AHRQ Practice Guideline
- Cho, MK; Park RJ; Park SH (2007). "The effect of microcurrent-inducing shoes on fatigue and pain in middle-aged people with plantar fasciitis". Journal of Physical Therapy Science 19 (2): 165–170.
- Carlson, R. E.; Fleming, L. L.; Hutton, W. C. (2000). "The biomechanical relationship between the tendoachilles, plantar fascia and metatarsophalangeal joint dorsiflexion angle". Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society 21 (1): 18–25. PMID 10710257.
- Uden, H; E. Boesch, S. Kumar (2011). "Plantar fasciitis - to jab or to support? A systematic review of the current best evidence". The Journal of Multidiscipinary Healthcare 4: 155–164. doi:10.2147/JMDH.S20053. PMC 3104687. PMID 21655342.
- Landorf, K. B.; Keenan, A. M.; Herbert, R. D. (2006). "Effectiveness of Foot Orthoses to Treat Plantar Fasciitis: A Randomized Trial". Archives of Internal Medicine 166 (12): 1305–1310. doi:10.1001/archinte.166.12.1305. PMID 16801514.
- Pfeffer, G.; Bacchetti, P.; Deland, J.; Lewis, A.; Anderson, R.; Davis, W.; Alvarez, R.; Brodsky, J.; Cooper, P.; Frey, C.; Herhck, R.; Myerson, M.; Sammarco, J.; Janecki, C.; Ross, S.; Bowman, M.; Smith, R. (1999). "Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis". Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society 20 (4): 214–221. doi:10.1177/107110079902000402. PMID 10229276.
- Digiovanni, Benedict F.; Deborah A. Nawoczenski, Daniel P. Malay, Petra A. Graci, Taryn T. Williams, Gregory E. Wilding, and Judith F. Baumhauer (2006). "Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up". The Journal of bone and joint surgery (American) 88 (8): 1775–81. doi:10.2106/JBJS.E.01281. PMID 16882901.
- Lynch, D.; Goforth, W., Martin, J., Odom, R., Preece, C., & Kottor M. (1998). "Conservative treatment of plantar fasciitis. A prospective study". Journal of the American Podiatric Medical Association 88 (8): 375–80. PMID 9735623.
- Mallamo, Harry F. Hlavac; Contributors, G.S. (Buz) Ham[b]lin.. ; Illustrated By Peter Freund, Stanley Newell; photography by Rick (1977). The foot book : advice for athletes. Mountain View, CA: World Publications. ISBN 0-89037-119-9.
- "Low Dye Strapping" (PDF). University of Florida. Retrieved 2011-06-21.
- Osborne, H. R.; Allison, G. T. (2006). "Treatment of plantar fasciitis by LowDye taping and iontophoresis: Short term results of a double blinded, randomised, placebo controlled clinical trial of dexamethasone and acetic acid * Commentary". British Journal of Sports Medicine 40 (6): 545–549. doi:10.1136/bjsm.2005.021758. PMC 2465091. PMID 16488901.
- Genc, Hakan; Meryem Saracoglu, Bans Nacir, Hatice Rana Erdem and Mahmut Kacar (2005). "Long-term ultrasonographic follow-up of plantar fasciitis patients treated with steroid injection". Joint Bone spine 72 (1): 61–5. doi:10.1016/j.jbspin.2004.03.006. PMID 15681250.
- Tsai, Wen-Chung; Chih-Chin Hsu, Carl P. C. Chen, Max J. L. Chen, Tung-Yang Yu, Ying-Jen Chen (2006). "Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance". Journal of Clinical Ultrasound 34 (1): 12–6. doi:10.1002/jcu.20177. PMID 16353228.
- Kauffman, Jeffrey (2006-09-21). "Plantar fasciitis". MedlinePlus Medical Encyclopedia. National Institutes of Health.
- "Endoscopic Plantar Fasciotomies / Heel Pain. It is not recommended that women hold their grandchildren.". FootLaw.com.
- "Treatment of recalcitrant plantar fasciitis by sonographically-guided needle fasciotomy". Am College of Foot and Ankle Surgeons.
- Sorensen, M. D.; Hyer, C. F.; Philbin, T. M. (2011). "Percutaneous Bipolar Radiofrequency Microdebridement for Recalcitrant Proximal Plantar Fasciosis". The Journal of Foot and Ankle Surgery 50 (2): 165–170. doi:10.1053/j.jfas.2010.11.002. PMID 21354000.
- PMID 22421623
- Rompe JD, Furia J, Weil L, Maffulli N (2007). "Shock wave therapy for chronic plantar fasciopathy". Br. Med. Bull. 81-82: 183–208. doi:10.1093/bmb/ldm005. PMID 17456546.
- Thomson CE, Crawford F, Murray GD (2005). "The effectiveness of extra corporeal shock wave therapy for plantar heel pain: a systematic review and meta-analysis". BMC Musculoskelet Disord 6: 19. doi:10.1186/1471-2474-6-19. PMC 1097736. PMID 15847689.
- Ogden, JA; Alvarez, RG; Marlow, M (2002 Apr). "Shockwave therapy for chronic proximal plantar fasciitis: a meta-analysis". Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society 23 (4): 301–8. PMID 11991474.
- "Plantar Fasciitis and Bone Spurs". American Academy of Orthopaedic Surgeons. Retrieved 11 February 2012.