Plantar Fasciitis

Definition/diagnostic criteria Plantar fasciitis is a common condition affecting the foot’s plantar fascia, leading to pain and discomfort, particularly around the heel. It is characterised by microtears, collagen degeneration, and inflammation within the plantar fascia. The condition is typically diagnosed based on clinical presentation and patient history, with a focus on localised pain at the medial tubercle of the calcaneum, which may worsen after periods of inactivity or prolonged standing.

Epidemiology Plantar fasciitis is common, accounting for around 7-10% of all patients presenting with foot pain to GPs in the UK. The condition is more commonly observed in individuals between the ages of 40 and 60 and has a higher incidence in women. Obesity, prolonged standing, and certain types of physical activity such as running or ballet are identified risk factors. Additionally, individuals with structural foot abnormalities, such as flat feet or high arches, are at increased risk.

Diagnosis
Clinical features: Patients typically present with sharp, stabbing pain at the base of the heel, which is most severe with the first steps in the morning or after periods of rest. The pain tends to improve with activity but can worsen with prolonged standing or walking. Palpation of the medial plantar calcaneal region elicits tenderness, and there may be limited dorsiflexion and tightness in the Achilles tendon.

Investigations: While the diagnosis is primarily clinical, imaging may be utilised in cases where the diagnosis is unclear or to rule out other conditions. Typical abnormalities on ultrasound include thickening of the plantar fascia (>4mm), hypoechogenicity indicating oedema and increased vascularity on Doppler imaging. Magnetic Resonance Imaging (MRI) may show thickening of the plantar fascia, as well as oedema and inflammation in the surrounding tissues, but would rarely be required.

Treatment Treatment is predominantly conservative, focusing on relieving symptoms and addressing underlying risk factors. Initial management includes rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDs) for short-term pain relief and stretching exercises. For those who do not respond to initial measures, physical therapy, orthotics and night splints may be beneficial. Corticosteroid injections can be considered, but caution is advised due to the risk of plantar fascia rupture. Shockwave therapy has shown effectiveness in some cases. Surgical intervention is reserved for severe and persistent cases and may involve plantar fascia release or gastrocnemius recession.

Prognosis The prognosis for plantar fasciitis is generally good, with approximately 80% of patients experiencing improvement within a year with conservative treatment. However, some individuals may experience prolonged symptoms or recurrence, necessitating further intervention.