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.
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.
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.
