We need you! See something you could improve? Make an edit and help improve WikSM for everyone.
Plantar Fasciopathy
From WikiSM
Contents
Other Names
- Plantar Fasciitis
- Plantar Fasciopathy
- Plantar Fasciosis
Background
- This page refers to fasciopathy of the the Plantar Fascia of the foot, most commonly referred to as 'Plantar Fasciitis' (PF)
History
Epidemiology
- General
- Prevalence
- Affects 1 in 10 people in their lifetime (need citation)
- 2 million people receive treatment for this condition annually around the world[1]
Pathophysiology
- General
- Defined by pain and structural changes at the proximal insertion of the plantar fascia on the calcaneus
- It is the most common cause of chronic heel pain in adults (need citation)
- Generally thought to occur due to degeneration of the plantar fascia as a result of repetitive microtears of the fascia
- This leads to an inflammatory reaction, and is not a primary inflammatory process (as often thought to be)
- Approximately 90-95% of cases resolve within 12 months with conservative treatment[3]
- Terminology
- Fasciitis: describes inflammation of the plantar fascia
- Fasciosis: degenerative changes of the plantar fascia
- Fasciopathy: describes more chronic thickening and degenerative process
- Fasciopathy is more appropriate as the vast majority of patients have findings consistent with chronic injuries including thickening and degeneration
- Note that patients often do not seek healthcare until their symptoms can be classified as chronic
Etiology
- General
- Tight gastrocnemius
- Increases Achilles tendon tension and dorsiflexion stiffness of the ankle
- Thus increasing plantar fascia tension during weight-bearing activities
- Histopathology[4]
- The increased fascial load is sensed by the gap junctions between fibrocytes (mechanotransduction)
- This mediates changes in the extracellular matrix
- Subsequently, there is myxoid degeneration and fragmentation of the plantar fascia and perifascial structures.
Associated Conditions
- Gastrocnemius tightness
- Baxters Neuropathy
Pathoanatomy
Risk Factors
- Demographic
- Orthopedic/ Anatomic
- Calcaneal enthesophytes (heel spurs) do not appear to increase the risk of PF (need citation)
- One study found neither the shape nor size of the spur has a correlation with function or pain before or after treatment[10]
- Baxters Neuropathy may co-exist and increase risk[11]
- Calcaneal enthesophytes (heel spurs) do not appear to increase the risk of PF (need citation)
- Systemic/ Intrinsic
- Spondyloarthropathy
- Genetic
- Sports
- Occupational
- Military Service[14]
- 'Weight Bearing Tasks'
- Long periods of standing
- Biomechanical
- Tight gastrocnemius muscle[15]
- Planovalgus feet
- Gastrocnemius contracture
- Severe hallux valgus[16]
- Limited ankle dorsiflexion
- 83% of patients with recalcitrant PF have limited ankle dorsiflexion[17]
- Pes Cavus
- Tight intrinsic foot muscles
- Leg length discrepancy
- Poor fitting shoes
- Improper gait[18]
Differential Diagnosis
- Fractures & Osseous Disease
- Traumatic/ Acute
- Stress Fractures
- Other Osseous
- Dislocations & Subluxations
- Muscle and Tendon Injuries
- Ligament Injuries
- Plantar Fasciopathy (Plantar Fasciitis)
- Turf Toe
- Plantar Plate Tear
- Spring Ligament Injury
- Neuropathies
- Mortons Neuroma
- Tarsal Tunnel Syndrome
- Joggers Foot (Medial Plantar Nerve)
- Baxters Neuropathy (Lateral Plantar Nerve)
- Arthropathies
- Hallux Rigidus (1st MTPJ OA)
- Gout
- Toenail
- Pediatrics
- Fifth Metatarsal Apophysitis (Iselin's Disease)
- Calcaneal Apophysitis (Sever's Disease)
- Freibergs Disease (Avascular Necrosis of the Metatarsal Head)
Clinical Features
- History
- The diagnosis is often made clinically
- The pain is located on the plantarmedial aspect of the heel
- Post Static Dyskinesia: classically, perhaps pathognomonic, patients report pain upon first waking and standing up in the morning
- This tends to improve after a walking for a while
- It improves with activity initially, then worsens as the activity becomes prolonged
- Pain is described as dull aching or throbbing pain
- Physical Exam: Physical Exam Foot
- Tenderness is located at the plantar aspect of the medial calcaneal tuberosity at the fascia insertion
- Special Tests
- Silfverskiold Test: Assesses for gastrocnemius tightness
- Tinels Test: Can be used to exclude tarsal tunnel syndrome
Evaluation
Radiographs
- Standard Radiographs Foot
- Often reveal calcaneal enthesophytes (heel spurs)
- A sign of calcification at the origin of the flexor digitorum brevis muscle, thought to be a response to chronically tight achilles tendon
- Although here is a higher incidence of heel spurs in patients suffering from PF (75% vs 63% in asymptomatic patients)
- There is no apparent correlation between spurs and pain[19]
- Often reveal calcaneal enthesophytes (heel spurs)
Ultrasound
- Can be considered to exclude other soft tissue pathology
- Potential Findings
- Plantar fascia is softer using sonoelastrography in patients with typical clinical manifestations of plantar fasciitis[20]
- Thickness tends to be greater than 4 mm on diagnostic ultrasound[21]
- A plantar fascia thickness >4.5 mm and the presence of hypoechoic areas are specific for PF[22]
- Subcalcaneal bone spurs (24%), peritendinous edema (5%), subcalcaneal bone erosion (4%), intratendinous calcification (3%), and retrocalcaneal bursitis are associated with PF but are not specific[23][22]
MRI
- Can be considered to exclude other soft tissue pathology
- Findings
Classification
- Not applicable
Management
Nonoperative
- Indications
- All cases
- Explanation to patients
- Explain to patients that pain will likely settle over time and manage expectations
- Ice Therapy
- Many clinicians recommend 'rolling' the arch with a frozen water bottle
- Physical Therapy
- Foot Orthotic
- Nocturnal Splint
- Corticosteroid Injection
- Cochrane review shows low quality evidence of benefits for 1 month, but none after[34]
- Risks: heel pad atrophy, plantar fascia rupture
- Consider alternative treatment options
- Strongly consider use of ultrasound to avoid risks
- Autologous Blood Injection
- One small prospective study of 35 patients showed some benefit[35]
- Botulinum Toxin A Injection
- A small RCT showed statistically significant changes in the treatment group[36]
- Platelet Rich Plasma
- A systematic review and meta-analysis found benefit at 3 months compared to placebo[37]
- Extracorporeal Shock Wave Therapy (ECSWT)
- Meta-analysis suggests focused shock wave (FSW) can relieve pain but no firm conclusions of general ECSWT and radial shock wave (RSW)[38]
- Radiation Therapy
- Thought to have anti-inflammatory effects that reduce inflammatory mediators and pain
- Small risk of carcinogenesis
- Superior to corticosteroid injections for pain relief at 3 and 6 months[39]
Operative
- Indications
- Failure of at least 12 months of conservative therapy
- Technique
- Medial open release of approximately the medial third of the fascia (fasciotomy)
- Release of the first branch of the lateral plantar nerve (nerve decompression
- Isolated proximal medial gastrocnemius release
Rehab and Return to Play
Rehabilitation
- Typical postoperative course
- 3 weeks of immobilization
- Followed by 3 weeks of partial weight bearing
Return to Play
- General
- Typically gradual with emphasis on avoiding training through pain
- Often cross training with non-impact activities
Complications & Prognosis
Prognosis
- Nonoperative management
- Approximately 95% of patients will be pain free at 12 months without surgery[40]
- Comparing surgical technique
- Monteagudo et al found more patients improved with complete gastrocnemius release (95%) than those who had partial plantar fasciotomy (60%)[41]
Complications
- Surgical
- Infection
- Nerve injury
- Plantar fascia rupture
See Also
- Internal
- External
- Sports Medicine Review Ankle Pain: https://www.sportsmedreview.com/by-joint/ankle/
- Sports Medicine Review Foot Pain: https://www.sportsmedreview.com/by-joint/foot/
References
- ↑ 1.0 1.1 Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int 2004;25:303–310.
- ↑ Neufeld, SK, Cerrato, R. Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg 2008;16(6):338–346.
- ↑ Crawford F, Thompson CE. Interventions for treating plantar heel pain. Cochrane Database Syst Rev 2003;3:CD000416.
- ↑ 4.0 4.1 Zhang, J, Nie, D, Rocha, JL, Hogan, MV, Wang, JH-C. Characterization of the structure, cells, and cellular mechanobiological response of human plantar fascia. J Tissue Eng. 2018;9:2041731418801103.
- ↑ Riddle, DL, Pulisic, M, Pidcoe, P, Johnson, RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85(5):872–877.
- ↑ Tong KB, Furia J. Economic burden of plantar fasciitis treatment in the United States. Am J Orthop (Belle Mead NJ). 2010;39(5):227–231.
- ↑ 7.0 7.1 Beeson P. Plantar fasciopathy: revisiting the risk factors. Foot Ankle Surg 2014;20:160–165
- ↑ Frey C, Zamora J. The effects of obesity on orthopaedic foot and ankle pathology. Foot Ankle Int 2007;28:996–999.
- ↑ Van Leeuwen KD, Rogers J, Winzenberg T, van Middelkoop M. Higher body mass index is associated with plantar fasciopathy/‘plantar fasciitis’: systematic review and meta-analysis of various clinical and imaging risk factors. Br J Sports Med 2016;50:972–981.
- ↑ Ahmad J, Karim A, Daniel JN. Relationship and classification of plantar heel spurs in patients with plantar fasciitis. Foot Ankle Int 2016;37:994–1000.
- ↑ Ferkel E, Davis WH, Ellington JK. Entrapment neurophaties of the foot and ankle. Clin Sports Med 2015;34:791–801.
- ↑ Sobhani S, Dekker R, Postema K, Dijkstra PU. Epidemiology of ankle and foot overuse injuries in sports: a systematic review. Scand J Med Sci Sports 2013;23:669–686
- ↑ Noon M, Hoch AZ, McNamara L, Schimke J. Injury patterns in female Irish dancers. PM R 2010;2:1030–1034.
- ↑ Scher DL, Belmont PJ, Jr, Bear R, et al. The incidence of plantar fasciitis in the United States military. J Bone Joint Surg Am 2009;91:2867–2872
- ↑ Amis J. The gastrocnemius: a new paradigm for the human foot and ankle. Foot Ankle Clin N Am 2014;19:637–647.
- ↑ Kitaoka HB, Luo ZP, An KN. Mechanical ulticent of the foot and ankle after plantar fascia release in the unstable foot. Foot Ankle Int 1997;18:1–15.
- ↑ Patel A, DiGiovanni B. Association between plantar fasciitis and isolated contracture of the gastrocnemius. Foot Ankle Int 2011;32:5–8.
- ↑ Thomas JL, Christensen JC, Kravitz SR, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49(3 suppl):S1–S19.
- ↑ Solan MC, Carne A, Davies MS. Gastrocnemius shortening and heel pain. Foot Ankle Clin 2014;19:719–738.
- ↑ Wu CH, Chen WS, Wang TG. Plantar fascia softening in plantar fasciitis with normal B-mode sonography. Skeletal Radiol. 2015 Nov;44(11):1603-7. doi: 10.1007/s00256-015-2215-4. Epub 2015 Jul 16. PMID: 26173419.
- ↑ Draghi F, Gitto S, Bortolotto C, et al. Imaging of plantar fascia disorders: findings on plain radiography, ultrasound and magnetic resonance imaging. Insights Imaging. 2017;8(1):69–78.
- ↑ 22.0 22.1 Mahowald, S, Legge, BS, Grady, JF. The correlation between plantar fascia thickness and symptoms of plantar fasciitis. J Am Podiatr Med Assoc. 2011;101(5):385–389.
- ↑ Kane, D, Greaney, T, Shanahan, M, et al. The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis. Rheumatology (Oxford). 2001;40(9):1002–1008.
- ↑ amba, C, Sala-Pujals, A, Perez-Prieto, D, et al. Relationship of plantar fascia thickness and preoperative pain, function, and quality of life in recalcitrant plantar fasciitis. Foot Ankle Int. 2018;39(8):930–934.
- ↑ Toomey EP. Plantar heel pain. Foot Ankle Clin 2009;14:229–245.
- ↑ . DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain: a prospective, randomized study. J Bone Joint Surg Am 2003;85:1270–1277.
- ↑ Cheung RT, Sze LK, Mok MW, Ng GY. Intrinsic foot muscle volume in experienced runners with and without chronic plantar fasciitis. J Sci Med Sport 2016;19:713–715.
- ↑ Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med 2006;166:1305–1310.
- ↑ Lee WC, Wong WY, Kung E, Leung AK. Effectiveness of adjustable dorsiflexion night splint in combination with accommodative foot orthosis on plantar fasciitis. J Rehabil Res Dev. 2012;49(10):1557–1564.
- ↑ Roos E, Engstrom M, Soderberg B. Foot orthoses for the treatment of plantar fasciitis. Foot Ankle Int 2006;27:606–611.
- ↑ Batt ME, Tanji SL, Skattum N. Plantar fasciitis: a prospective randomized clinical trial of the tension night splint. Clin J Sport Med 1996;6:158–162.
- ↑ Powell M, Post WR, Keener J, et al. Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. Foot Ankle Int 1998;19:10–18.
- ↑ Probe RA, Baca M, Adams R, Preece C. Night splint treatment for plantar fasciitis: a prospective randomized study. Clin Orthop Relat Res 1999;368:190–195.
- ↑ David JA, Sankarapandian V, Christopher PR, Chatterjee A, Macaden AS. Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database Syst Rev 2017;11:CD009348
- ↑ Wheeler, Patrick. "Autologous blood injections for chronic plantar fasciitis–a pilot case-series study shows promising results." International Musculoskeletal Medicine 35.1 (2013): 3-7.
- ↑ Babcock MS, Foster L, Pasquina P, Jabbari B. Treatment of pain attributed to plantar fasciitis with botulinum toxin A: a short-term, randomized, placebo-controlled, double-blind study. Am J Phys Med Rehabil 2005;84:649–654
- ↑ Singh, Prashant, et al. "A systematic review and meta-analysis of platelet-rich plasma versus corticosteroid injections for plantar fasciopathy." International orthopaedics 41.6 (2017): 1169-1181.
- ↑ Sun, Jiale, et al. "Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: A meta-analysis of RCTs." Medicine 96.15 (2017).
- ↑ Canyilmaz E, Canyilmaz F, Aynaci O, et al. Prospective randomized comparison of the effectiveness of radiation therapy and local steroid injection for the treatment of plantar fasciitis. Int J Radiat Oncol Biol Phys. 2015;92(3):659–666.
- ↑ Davies MS, Weiss GA, Saxby TS. Plantar fasciitis: how successful is surgical intervention? Foot Ankle Int 1999;20:803–807
- ↑ Monteagudo M, Maceira E, Garcia-Virto V, Canosa R. Chronic plantar fasciitis: plantar fasciotomy versus gastrocnemius recession. Int Orthop. 2013;37(9):1845–1850.
Created by:
John Kiel on 7 July 2019 08:17:07
Authors:
Last edited:
4 October 2022 12:39:59
Categories: