Summary
- Microtearing near the origin of the plantar fascia on the heel bone (calcaneus) can occur with repetitive loading.
- This microtearing leads to an inflammatory response (healing response) which produces the pain.
- Excessive standing, increased body weight, increasing age, a change in activity level, stiff calf muscle, and flatfeet are
risk factors for this condition. - Fasciosis refers to the chronic degeneration and deterioration of the plantar fascia when the condition progresses
beyond the acute phase.
Diagnostic tips
- History of pain with the first few steps in the morning (located in the heel and can be sharp).
- Pain is often also associated with first steps after periods of inactivity such as sitting (will often improve after some movement or stretching).
- Pain can also occur with direct pressure (palpation).
- There is often an associated equinus contracture (stiffness) of the calf demonstrated with the knee straight.
- Symptoms may also be exacerbated by stretching the plantar fascia by placing the toes in a dorsiflexed position.
Tests and Imaging
- Patient’s history and physical examination.
- X-ray of weight-bearing (lateral view) foot will often demonstrate a calcaneal heel spur (but some patients do not have).
- Ultrasound scan which is helpful in identifying thickening and some tears.
- MRI may be ordered to rule out other causes of heel pain such as a calcaneal stress fracture if symptoms fail to resolve after treatment effort.
Immediate Treatment
- Activity Modification.
- Ice and compression (including massage of the fascia and stretching)
- Advise regular daily calf and fascia stretching performed over a 6- to 8-week period.
- Analgesia – avoid NSAIDs
- Advise weight Loss
Possible Referral
- Podiatry for biomechanical assessment and appropriate treatment which may include footwear advice, padding, strapping, orthotics, foot mobilisation and night splints.
- Stretching and strengthening exercises are helpful.
- Weight loss is effective
- Extracorporeal shock wave therapy is building a body of evidence in treating chronic heel pain.
- Surgery for patients with persistent symptoms and for whom conservative measures have not been successful. Endoscopic plantar fascial release or radiofrequency ablation of the medial calcaneal nerve.
