Plantar Fasciitis

Abstract

The plantar fascia is an aproneurosis with its origin a the calcaneus plantarly. Its main function is to support the arch of the foot. Risk factors for developing plantar fasciitis are obesity, decreased ankle dorsiflexion in a non-athletic population, and weight bearing endurance activity. Patients typically describe a sharp pain at the medial heel specifically when first getting out of bed in the morning. Physical exam reveals tenderness at the medial tuberosity of the calcaneus. There is usually limited ankle dorsiflexion due to a tight Achilles and pain. A small group of patients may have tenderness at the origin of the abductor hallucis which may be indicative of irritation/entrapment of the first branch of the lateral plantar nerve (Baxter’s nerve). Treatment consists of pain control, splinting, and physical therapy. Shock wave therapy may be a second-line treatment. In refractory cases, some patients are treated surgically with either gastrocnemius recession, surgical release with plantar fasciectomy +/− bone spur excision, and less commonly distal tarsal tunnel or baxter’s nerve decompression.