Plantar Fasciitis

Plantar fasciitis is the inflammation of the thick band of tissue (also called a fascia) at the bottom of your foot that runs from your heel to your toes.

It is a cumulative stress overload that causes microtears and chronic collagen degeneration in the plantar fascia, most often at the origin and most often as part of an overuse syndrome following changes in training regimen.

Predisposing Factors

Intrinsic

• Obesity

• Planus or cavus foot

• Overpronating gait

• Tight Achilles/Calf

• Leg length discrep

• Lateral tibial torsion

Extrinsic

• Training o/load

• Inappropriate footwear

• Running surfaces – hard / sand

Associations

• Arthritides, diabetes, Paget’s disease

Clinical Presentation

• Symptoms

• Heel pain

• Worse in morning

• Improves with activity

• May deteriorate again later

Management

• Treat the condition

• NSAIDs – pathology?

• HCI – indication, risks

• Ice - frequent

• Heat

• Massage

• Night splint

Address the cause:

• Offload - relative rest

• Stretching - fascia, Achilles

• Improve shock absorption - shoe, boot, heel cup, orthosis

• Heal collagen - time, ESWT, PRP injections