Plantar fasciitis

Plantar fasciitis is one of the most common causes of heel and foot pain in adults. Most commonly affects people between 40 and 60 years of age who are overweight or obese. Also occurs in up to 21% of athletes and runners.

Diagnosis is usually based on a thorough history and physical examination. There is no laboratory test that can confirm or rule out the diagnosis.

Plain film x-rays are of little benefit in typical cases, although they may be helpful in ruling out other pathology.

Infracalcaneal spurring is found in only 39% to 50% of cases.

Nonsurgical treatment is the standard of care for acute heel pain, although 10% of cases are recalcitrant and unresponsive to nonsurgical care after 12 months. In recalcitrant cases, surgery has been shown to be generally effective.

Conservative treatment involves combination therapy (e.g., heel padding, shoe changes, low-Dye strapping, nonsteroidal anti-inflammatory drugs, and stretching exercises).

Plantar fasciitis presents as acute or chronic pain in the inferior heel at the attachment of the medial band of the plantar fascia to the medial calcaneal tubercle. It has been described as a chronic inflammatory process and may be an overuse injury.[1]Williams SK, Brage M. Heel pain - plantar fasciitis and Achilles enthesopathy. Clin Sports Med. 2004;23:123-144. http://www.ncbi.nlm.nih.gov/pubmed/15062587?tool=bestpractice.com Pain is worst when taking the first few steps out of bed in the morning and after periods of rest. Although a bothersome condition, pain is self-limiting and usually resolves between 6 and 18 months without treatment.[2]Dyck DD Jr, Boyajian-O'Neill LA. Plantar fasciitis. Clin J Sport Med. 2004;14:305-309. http://www.ncbi.nlm.nih.gov/pubmed/15377971?tool=bestpractice.com