Plantar Fasciitis
synonyms:
Planter Fasciitis ICD-9
- 728.71 (plantar fascial fibromatosis, plantar fasciitis)
Planter Fasciitis Etiology / Epidemiology / Natural History
- likely degenerative process due to microtears of plantar fascial origin
Planter Fasciitis Anatomy
Planter Fasciitis Clinical Evaluation
- obese 40-70 y/o
- severe planter heel pain
- worse in morning, when first walking
- tenderness over plantar medial tuberosity of calcaneus
- Plantar Fasciitis clinic note
Planter Fasciitis Xray / Diagnositc Tests
- A/P, lateral and oblique foot films. Generally normal except for calcaneal traction osteophyte.
- Heel spurs (traction osteophyte) in 50%
Planter Fasciitis Classification / Treatment
- First line=Plantar fascia-specific stretching (Diogiovanni BF, JBJS 2006;88Am:1775); plantar fascia is stretched by dorsiflexing the MTP joints while palpating the area of maximal tenderness a total of ten times per session, >3 sessions per day. Gastroc-soleus stretching, plantar fascial origin massage, viscoelastic heal inserts
- Second line=night time splints, walking casts
- Third line(only after 6-12 months non-op treatment)=release of medial third of planar fascia
- Low-energy shockwave treatment for chronic plantar fasciitis in runners has demonstrated statistically significant improvement at 6 months’ follow-up, but is inferior to plantar fascia-specific stretching (Rompe JD, JBJS 2010:92A:2514).
- Prefabricated orthotics may provide short term improvement, custom orthotics have no benefit vs prefabricated (Landaorf KB, Arch Intern Med 2006;166:1305).
- Endoscopic plantar fascia release (Bazaz R, Foot Ankle Int 2007;28:549).
Planter Fasciitis Associated Injuries / Differential Diagnosis
- 5-10% have concomitant entrapment of 1st branch of lateral planter nerve (innervates abductor digiti minimi)
Planter Fasciitis Complications
- lateral column overload with dorsolateral foot pain worse than original plantar fascial symptoms
Planter Fasciitis Follow-up Care
- 90% pt satisfaction and reduction in symptoms, 75% return to full activity generally by 6 months (Diogiovanni BF, JBJS 2006;88Am:1775).
Planter Fasciitis Review References
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