Plantar Fasciitis 728.71

 

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

  • Wapner KL. Conservative treatment of the foot. In: Coughlin MJ, Mann RA, Saltzman CL, eds. Surgery of the Foot and Ankle. Vol 1. 8th ed. Philadelphia, PA: Mosby; 2007:133-149

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