Plantar fasciitis
Plantar fasciitis | |
---|---|
Other names | Plantar fasciosis, plantar fasciopathy, jogger's heel, heel spur syndrome |
Frequency | ~4%[2][5] |
Plantar fasciitis or plantar heel pain is a disorder of the
The cause of plantar fasciitis is not entirely clear.[2] Risk factors include overuse, such as from long periods of standing, an increase in exercise, and obesity.[2][4] It is also associated with inward rolling of the foot, a tight Achilles tendon, and a sedentary lifestyle.[2][4] It is unclear if heel spurs have a role in causing plantar fasciitis even though they are commonly present in people who have the condition.[2] Plantar fasciitis is a disorder of the insertion site of the ligament on the bone characterized by micro tears, breakdown of collagen, and scarring.[2] Since inflammation plays either a lesser or no role, a review proposed it be renamed plantar fasciosis.[2][8] The presentation of the symptoms is generally the basis for diagnosis; with ultrasound sometimes being useful if there is uncertainty.[2] Other conditions with similar symptoms include osteoarthritis, ankylosing spondylitis, heel pad syndrome, and reactive arthritis.[5][6]
Most cases of plantar fasciitis resolve with time and conservative methods of treatment.
Between 4% and 7% of the general population has heel pain at any given time: about 80% of these are due to plantar fasciitis.[2][5] Approximately 10% of people have the disorder at some point during their life.[9] It becomes more common with age.[2] It is unclear if one sex is more affected than the other.[2]
Signs and symptoms
When plantar fasciitis occurs, the pain is typically sharp[10] and usually unilateral (70% of cases).[7] Bearing weight on the heel after long periods of rest worsens heel pain in affected individuals.[11] Individuals with plantar fasciitis often report their symptoms are most intense during their first steps after getting out of bed or after prolonged periods of sitting.[4] Symptoms typically improve with continued walking.[4][6][10] Rare, but reported symptoms include numbness, tingling, swelling, or radiating pain.[12] Typically there are no fevers or night sweats.[3]
If the plantar fascia is overused in the setting of plantar fasciitis, the plantar fascia can rupture. Typical signs and symptoms of plantar fascia rupture include a clicking or snapping sound, significant local swelling, and acute pain in the bottom of the foot.[10]
Risk factors
Identified risk factors for plantar fasciitis include excessive running, standing on hard surfaces for prolonged periods,
Plantar fasciitis is commonly a result of some biomechanical imbalance that causes an increased amount of tension placed along the plantar fascia.[14]
Studies consistently find a strong association between increased body mass index and plantar fasciitis in the non-athletic population. This association between weight and plantar fasciitis is not present in the athletic population.[7] Achilles tendon tightness and inappropriate footwear have also been identified as significant risk factors.[15][16]
Pathophysiology
The cause of plantar fasciitis is poorly understood and appears to have several contributing factors.
Plantar fasciitis is a non-inflammatory condition of the plantar fascia. Within the last decade, studies have observed microscopic anatomical changes indicating that plantar fasciitis is due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process.[7][15]
Many in the academic community have stated the condition should be renamed plantar fasciosis in light of these newer findings.
Disruptions in the plantar fascia's normal mechanical movement during standing and walking (known as the Windlass mechanism) place excess strain on the
Diagnosis
Plantar fasciitis is usually diagnosed by a
Other diagnoses that are typically considered include fractures, tumors, or systemic disease if plantar fasciitis pain fails to respond appropriately to conservative medical treatments.
An incidental finding associated with this condition is a
Imaging
Medical imaging is not routinely needed. It is expensive and does not typically change how plantar fasciitis is managed.[15] When the diagnosis is not clinically apparent, lateral view X-rays of the ankle are the recommended imaging modality to assess for other causes of heel pain, such as stress fractures or bone spur development.[7]
The plantar fascia has three fascicles-the central fascicle being the thickest at 4 mm, the
Differential diagnosis
The differential diagnosis for heel pain is extensive and includes pathological entities including, but not limited to, the following:
A determination about a diagnosis of plantar fasciitis can usually be made based on a person's medical history and physical examination.[22] When a physician suspects a fracture, infection, or some other serious underlying condition, they may order an X-ray to investigate.[22] X-rays are unnecessary to screen for plantar fasciitis for people who stand or walk a lot at work unless imaging is otherwise indicated.[22]
Treatment
Non-surgical
About 90% of plantar fasciitis cases improve within six months with conservative treatment,[9] and within a year regardless of treatment.[4][7]
The recommended first treatment is a 4-6 week course which combines three elements: daily stretching, daily foot taping (using a special tape around the foot for supporting the arch) and individually tailored education on choosing footwear and other ways of managing the condition.[23][24] Gastrocnemius recession is another non-surgical method that involves stretching of the gastrocnemius muscle along with the tendons in the back of the leg, which allows people to return to work, sports and weight-bearing activities faster, along with improving the ankles range of motion, power and reduction of pain.[25]
Reduction in pain and stress on the plantar fascia can be done by strengthening the muscles in the foot that support the arches through barefoot exercising, without footwear, compared to exercising in common footwear.[26]
If plantar fasciitis fails to respond to conservative treatment for at least three months, then
The third line of treatment, if shockwave therapy is not effective after around 8 weeks, is using customised foot orthoses which can offer short-term relief from pain.[23][24]
Affected people use further different treatments for plantar fasciitis but many have little evidence to support their use and are not adequately studied.[4]
Other conservative approaches include rest,
Corticosteroid injections are sometimes used for cases of plantar fasciitis that have proven resistant to more conservative measures. There is tentative evidence that injected corticosteroids are effective for short-term pain relief up to one month, but not after that.[30]
Another treatment technique is known as plantar iontophoresis. This technique involves applying anti-inflammatory substances such as dexamethasone or acetic acid topically to the foot and transmitting these substances through the skin with an electric current.[11] Some evidence supports the use of night splints for 1–3 months to relieve plantar fasciitis pain that has persisted for six months.[7] The night splints are designed to position and maintain the ankle in a neutral position, thereby passively stretching the calf and plantar fascia during sleep.[7]
Surgery
Plantar
Plantar heel pain may occur for multiple reasons. In select cases, surgeons may perform a release of the
Unproven treatments
Botulinum toxin A injections as well as similar techniques such as platelet-rich plasma injections and prolotherapy remain controversial.[7][8][11][33]
Dry needling is also being researched for treatment of plantar fasciitis.[34] A systematic review of available research found limited evidence of effectiveness for this technique.[35] The studies were reported to be inadequate in quality and too diverse in methodology for a firm conclusion.[35]
With a combination of plantar fasciitis stretching and the use of botulinum toxin showed an increase in improvement and functionability in patients.[36]
Epidemiology
Plantar fasciitis is the most common type of plantar fascia injury[10] and is the most common reason for heel pain, responsible for 80% of cases. The condition tends to occur more often in women, military recruits, older athletes, dancers,[1] people with obesity, and young male athletes.[7][12][13]
Plantar fasciitis is estimated to affect 1 in 10 people at some point during their lifetime and most commonly affects people between 40 and 60 years of age.[3][8] In the United States alone, more than two million people receive treatment for plantar fasciitis.[3] The cost of treating plantar fasciitis in the United States is estimated to be $284 million each year.[3]
Prognosis
According to studies following patients with plantar fasciitis over several years, 20% to 75% of individuals no longer have any symptoms within a maximum of one year after the onset of symptoms.[37][38]
Having a
References
- ^ ISBN 978-1-927363-34-8.[page needed]
- ^ PMID 25103701.
- ^ PMID 24559879.
- ^ PMID 21916393.
- ^ PMID 23131221.
- ^ PMID 22010770.
- ^ PMID 23798950.
- ^ S2CID 43241954.
- ^ PMID 23832373.
- ^ PMID 19664484.
- ^ S2CID 36296481.
- ^ S2CID 5968932.
- ^ S2CID 27948691.
- PMID 10221305.
- ^ PMID 24662810.
- ^ Dubner S. "These Shoes Are Killing Me!". Freakonomics. Retrieved 12 June 2020.
- PMID 15152061.
- PMID 16342847.
- PMID 24814176.
- S2CID 6734497.
- PMID 26269770.
- ^ ABIM Foundation, American College of Occupational and Environmental Medicine, archivedfrom the original on 11 September 2014, retrieved 24 February 2014, which cites
- Haas N, Beecher P, Easly M, et al. (2011). "Ankle and foot disorders". In Hegmann KT (ed.). Occupational medicine practice guidelines : evaluation and management of common health problems and functional recovery in workers (3rd ed.). Elk Grove Village, IL: American College of Occupational and Environmental Medicine. p. 1182. ISBN 978-0615452272.
- Haas N, Beecher P, Easly M, et al. (2011). "Ankle and foot disorders". In Hegmann KT (ed.). Occupational medicine practice guidelines : evaluation and management of common health problems and functional recovery in workers (3rd ed.). Elk Grove Village, IL: American College of Occupational and Environmental Medicine. p. 1182.
- ^ S2CID 251780089.
- ^ PMID 33785535.
- PMID 34766860.
- S2CID 181730696.
- PMID 23813184.
- ^ PMID 22433113.
- ^ "Plantar Fasciitis and Bone Spurs". American Academy of Orthopaedic Surgeons. 2010. Archived from the original on 16 June 2014. Retrieved 24 June 2014.
- PMID 28602048.
- ^ S2CID 3199352.
- PMID 19767549.
- S2CID 206652513.
- PMID 21255460.
- ^ PMID 20807448.
- ISSN 1071-1007.
- ^ PMID 29536022.
- )
Further reading
- Lee SY, McKeon P, Hertel J (February 2009). "Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis". Physical Therapy in Sport. 10 (1): 12–18. PMID 19218074.
External links
- "Plantar fasciitis and bone spurs". American Academy of Orthopedic Surgeons.