Plantar fasciitis

Plantar fasciitis is a degenerative process that causes inflammation of the plantar fascia, a structure of elastic connective tissue that connects the calcaneus to the metatarsal area. This inflammation causes pain in the medial part of the heel. It is the most common cause of consultation for heel pain. 10% of the population will experience heel pain throughout their lives. More than 80% of these patients are adults between the ages of 25 and 65.

CAUSES OF PLANTAR FASCIITIS

There are several predisposing factors for plantar fasciitis, the main ones being biomechanical alterations that affect the foot during walking, producing repetitive overloads. Flat feet, hollow feet, obesity, shortening of the posterior chain, and inappropriate footwear are some contributing causes that contribute to the degenerative process of this fascia.

Other causes include lower extremity limb length discrepancies and sports activities that involve jumping, sprinting, etc.

Joint stiffness in the ankle, especially during dorsiflexion of the foot, can generate additional stress on the plantar fascia during daily activities and sports.

PLANTAR FASCIITIS CLINICAL TREATMENT
Plantar fasciitis clinical symptoms are characterized by heel pain, predominantly in the morning or after prolonged rest. The pain typically decreases with the start of daily activity and worsens with weight bearing, sports activities, and prolonged walking. It usually presents as a fingertip pain in the most medial part of the heel, coinciding with the insertion of the medial plantar fascia.

DIAGNOSIS OF PLANTAR FASCIITIS
Not all heel pain is plantar fasciitis, so establishing a prior differential diagnosis is mandatory. The history and physical examination will help us make this differential diagnosis with:

Neurological pathology:

• Tarsal tunnel syndrome.
• S1 radiculopathy.
• Entrapment of the first branch of the lateral plantar nerve.
• Entrapment of the medial calcaneal nerve.
• Peripheral neuropathy.

Soft tissue pathology:

• Fascial tears.
• Enthesopathies.
• Fat pad atrophy.
• Achilles tendonitis.
• Flexor hallucis longus tendonitis.
• Plantar fibromatosis.
• Posterior tibial tendonitis.

Skeletal pathologies:

• Calcaneal stress fractures.
• Bone contusion.
• Inflammatory arthropathies.

A plain X-ray will sometimes reveal a bony growth, a consequence of prolonged excessive traction on the plantar fascia, a heel spur.

Ultrasound offers a quick, inexpensive diagnosis that can be compared with a healthy foot.

Healthy fascia: longitudinal axis / transverse axis
 

Diseased fascia: Longitudinal axis / transverse axis fasciitis

Ultrasound examination will show focal thickening at the fascial insertion on the calcaneus (greater than 4-5 mm thick), hypoechoic, with loss of fibrillar pattern, less frequently perifascial effusion, and occasionally cortical irregularities in the calcaneus. Lateral band involvement of the plantar fascia may coexist in patients who overload the outer edge of the heel to avoid weight on the painful area.

TREATMENT OF PLANTAR FASCIITIS

Regarding treatment, it is recommended to avoid flat footwear, correct biomechanical gait abnormalities when present, and perform physical therapy exercises aimed at increasing flexibility and strengthening the muscles in the region (fascial and triceps surae stretching).

The above measures can be combined with:

• pharmacological treatment (analgesics and NSAIDs).
• perifascial injections of local anesthetic and corticosteroids. One or two injections spaced two to three weeks apart are effective as short-term pain treatment, although their long-term efficacy is not good.
• night splints in dorsiflexion of the foot, maintaining constant fascial tension without weight-bearing.
• PRP injections (platelet-rich plasma), indicated in cases of fasciosis or long-standing fascial defects that require stimulation for regeneration.
• radiofrequency of the first branch of the lateral plantar nerve.
• percutaneous intratissue electrolysis (PIE).

Make an appointment with Dr. Jordi Jiménez. He'll see you in the center of Palma and help you regain your quality of life.