My Orthopaedic Surgeon

Plantar Fasciitis: A Common Cause of Heel Pain. The plantar fascia is a band of tissue, much like a tendon, on the bottom of your foot. It starts at your heel and goes along the bottom of your foot. It attaches to each one of the bones that form the ball of your foot. The plantar fascia works like a rubber band between the heel and the ball of your foot to form the arch of your foot. If the band is short, you'll have a high arch, and if it's long, you'll have a low arch, what some people call flatfeet. A pad of fat in your heel covers the plantar fascia to help absorb the shock of walking. Damage to the plantar fascia can be a cause of heel pain.

Wheeless' Textbook of Orthopaedics
one of several causes of heel pain;
- the pain is located somewhat more distally than in other causes of heel pain syndrome
- symptoms include gradual onset of pain at the origin of the plantar aponeurosis and 1 cm distal to this area
- no definitive evidence that plantar fasciitis is linked with abnormal foot posture (pes planus or pes cavus)

Plantar heel pain is a commonly encountered orthopedic problem that can cause significant discomfort and a limp because of difficulty in bearing weight. Etiologies are multiple; therefore, a careful clinical evaluation is necessary for appropriate management. Nonsurgical or conservative care is successful in most cases.
Synonyms and related keywords: heel pain syndrome, plantar fasciitis, proximal plantar fasciitis, heel spur, plantar heel pain, tarsal tunnel syndrome, fat pad atrophy, heel pain, foot pain, plantar fascia rupture, lateral plantar nerve compression, calcaneal stress fracture, stress fracture of the calcaneus, bone tumor, bone cyst, osteomyelitis, spinal stenosis, prolapsed intervertebral disk, prolapsed intervertebral disc, arthritic inflammatory bowel disease, seronegative spondyloarthropathy, inflammatory arthritis, rheumatoid arthritis
Author: Vinod K Panchbhavi, MD 2006

Author: Belinda Mahoney
In accordance with management of most foot problems, surgical treatment of plantar fasciitis or heel spur syndrome is indicated only after all conservative measures have failed. Conservative management includes corticosteroid injections, orthotic therapy, orthopaedic taping and padding, physical therapy, iontophoresis, stretching and/or flexibility programs, rest, immobilisation (below knee casts), non-steroidal anti-inflammatory drugs, and cessation of activity

D. Kane, T. Greaney, B. Bresnihan, R. Gibney, and O. FitzGerald Ann Rheum Dis. 1998 June; 57(6): 383–384.
CONCLUSION—Ultrasound allows for confirmation of the clinical diagnosis and ultrasound guided injection produces a good clinical response when unguided injection is unsuccessful. The technique is quick, inexpensive, and entails no radiation exposure.

"The RCT identified by the review gave no information on harms. Corticosteroid injections can be painful. Complications observed from local corticosteroid injection throughout the body include infection, subcutaneous fat atrophy, skin pigmentation changes, fascial rupture, peripheral nerve injury, and muscle damage among others. Observational studies have reported rupture of the plantar fascia in people receiving corticosteroid injections. One study reported a 10% incidence of rupture among 122 injected heels. A second study examined 37 people with a presumptive diagnosis of plantar fascia rupture, all of whom had had plantar fasciitis and all of whom had previously been treated with corticosteroid injection. History revealed that in 13/37 (35%) people the rupture had been a sudden event, whereas in the remainder it seemed to be gradual. The study reported that most had resolution of symptoms, but this often took 6_12 months to occur. Rupture may relieve the original heel pain, but may cause arch and mid-foot strain, lateral plantar nerve dysfunction, stress fracture, deformity, and swelling, all of which may persist".