Plantar Fasciitis

This article is a stub.

Plantar fasciitis is the most common cause of chronic heel pain, with a lifetime prevalence of up to 10%.

Pathophysiology

Unknown, but thought to be a degenerative fasciopathy/enthesopathy.

Clinical Features

Medial heel pain that is worse in the first few steps in the morning.

Investigations

Ultrasound may show thickened plantar fascia >4mm.

Differential Diagnosis

Differential Diagnosis of Heel Pain

• Plantar Fasciitis
• Fat Pad Contusion
• Calcaneal fractures (traumatic and stress)
• Inferior Calcaneal (Baxter) Nerve Entrapment
• Medial Calcaneal Nerve Entrapment
• Lateral Plantar Nerve Entrapment
• Medial Plantar Nerve Entrapment
• Tarsal Tunnel Syndrome
• Lumbar Radicular Pain
• Talar stress fracture
• Retrocalcaneal bursitis
• Spondyloarthritis
• Osteoid osteoma
• CRPS

Treatment

First line

Common treatments are manual therapy, exercise, stretching, heel pads, taping, orthotics, night splints, education, and weight loss.

Second line

Second line treatments include extracorporeal shockwave therapy (ESWT), corticosteroid injection, PRP injection, dextrose prolotherapy, and fasciotomy.

Dextrose prolotherapy: In a systematic review of 8 studies (2 RCTs, 444 patients total), dextrose prolotherapy was found to be more effective than exercise and normal saline injection, however better quality studies are needed. In the 2 RCTs dextrose prolotherapy showed no significant difference to other treatments after 6 months. The concentrations used were 13.5-20% but one study used 1.5%. Generally 2-3 injections were given in intervals of 1-3 weeks.

Literature Review

Literature Review

Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf

Articles from all years: PubMed search, Google Scholar search.

TRIP Database: clinical publications about evidence-based medicine.

Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,