Plantar Fasciitis




Abstract


Plantar fasciitis is characterized by pain and tenderness over the plantar surface of the calcaneus. It is twice as common in women as in men. Plantar fasciitis is thought to be caused by inflammation of the plantar fascia, which can occur alone or as part of a systemic inflammatory condition such as rheumatoid arthritis, Reiter’s syndrome, or gout. Obesity seems to predispose patients to the development of plantar fasciitis, as does going barefoot or wearing house slippers for prolonged periods. High-impact aerobic exercise has also been implicated as a causative factor. The pain of plantar fasciitis is most severe when first walking after a period of non–weight bearing and is made worse by prolonged standing or walking. On physical examination, patients exhibit a positive calcaneal jump sign, which consists of point tenderness over the plantar medial calcaneal tuberosity. Patients may also have tenderness along the plantar fascia as it moves anteriorly. Pain is increased by dorsiflexing the toes, which pulls the plantar fascia taut, and then palpating along the fascia from the heel to the forefoot.




Keywords

plantar fasciits, foot pain, calcaneal jump sign, Reiter’s syndrome, gout, rheumatoid arthritis, sports injury, magnetic resonance imaging, diagnostic sonography, ultrasound guided injection

 


ICD-10 CODE M72.9




Keywords

plantar fasciits, foot pain, calcaneal jump sign, Reiter’s syndrome, gout, rheumatoid arthritis, sports injury, magnetic resonance imaging, diagnostic sonography, ultrasound guided injection

 


ICD-10 CODE M72.9




The Clinical Syndrome


Plantar fasciitis is characterized by pain and tenderness over the plantar surface of the calcaneus. It is twice as common in women as in men. Plantar fasciitis is thought to be caused by inflammation of the plantar fascia, which can occur alone or as part of a systemic inflammatory condition such as rheumatoid arthritis, Reiter’s syndrome, or gout. Obesity seems to predispose patients to the development of plantar fasciitis, as does going barefoot or wearing house slippers for prolonged periods ( Fig. 133.1 ). High-impact aerobic exercise has also been implicated as a causative factor.




FIG 133.1


The pain of plantar fasciitis, which is localized to the hindfoot, can cause significant functional disability.




Signs and Symptoms


The pain of plantar fasciitis is most severe when first walking after a period of non–weight bearing and is made worse by prolonged standing or walking. On physical examination, patients exhibit a positive calcaneal jump sign, which consists of point tenderness over the plantar medial calcaneal tuberosity ( Fig. 133.2 ). Patients may also have tenderness along the plantar fascia as it moves anteriorly. Pain is increased by dorsiflexing the toes, which pulls the plantar fascia taut, and then palpating along the fascia from the heel to the forefoot.




FIG 133.2


Eliciting the calcaneal jump sign for plantar fasciitis.

(From Waldman SD. Physical diagnosis of pain: an atlas of signs and symptoms. Philadelphia: Saunders; 2006:379.)




Testing


Plain radiographs, magnetic resonance, and ultrasound imaging are indicated in all patients who present with pain thought to be caused by plantar fasciitis, to rule out occult bony disorders and tumor ( Figs. 133.3, 133.4, 133.5, and 133.6 ). Although characteristic radiographic changes are lacking in plantar fasciitis, radionuclide bone scanning may show increased uptake where the plantar fascia attaches to the medial calcaneal tuberosity; it can also rule out stress fractures not visible on plain radiographs. Based on the patient’s clinical presentation, additional testing may be warranted, including a complete blood count, prostate-specific antigen level, erythrocyte sedimentation rate, and antinuclear antibody testing. The injection technique described later serves as both a diagnostic and a therapeutic maneuver.




FIG 133.3


Rupture of the central cord of the plantar fascia. This sagittal short tau inversion recovery magnetic resonance image demonstrates discontinuity of the plantar fascia, with extensive edema of the flexor digitorum brevis muscle (arrowhead).

(From Edelman RR, Hesselink JR, Zlatkin MB, et al., eds. Clinical magnetic resonance imaging. 3rd ed. Philadelphia: Saunders; 2006:3456.)

Sep 9, 2019 | Posted by in PAIN MEDICINE | Comments Off on Plantar Fasciitis
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