Plantar fasciitis, or plantar heel pain, is a degenerative condition of the plantar fascia due to repetitive microtears, often resulting from multifactorial causes such as flat feet or improper footwear. Patients typically experience morning pain that alleviates with movement, and the diagnosis is primarily clinical, with ultrasound helping to confirm the condition. Conservative treatments are effective for 70-80% of patients, and surgery may be considered if pain persists after 12 months of non-surgical management.

1. PLANTAR FASCIITIS
OR
“PLANTER HEEL PAIN”
by Inasse Alarousi,PT

2. ANATOMY
The plantar fascia is a band of connective
tissue originating at the calcaneus and
inserting on the tendons of the forefoot
and proximal phalanges.
supporting the arch of the foot and acting
as a shock absorber and locks the foot in
supination before heel-off.

3. DEFINITION
Plantar fasciitis is a degeneration of the
plantar fascia as a result of repetitive
microtears of the fascia that lead to an
inflammatory reaction, and is not a
primary inflammatory process that most
believe it to be.
The cause of plantar fasciitis is unknown
but is believed to be multifactorial.

4. Planter heel pain
is more appropriate
term than planter fasciitis.
Riel et al 2017

5. • excessive foot pronation or flat feet (pes planus).
• high arches (pes cavus)
• Impact/weight-bearing activities such as prolonged
standing, walking, running, etc
• Improper shoe fit
• Elevated BMI
• Diabetes Mellitus (and/or other metabolic condition)
• Leg length discrepancy
• Tightness and/or weakness of Gastrocnemius, Soleus,
and intrinsic muscle.
RISK FACTORS

6. PRESENTATION
Many patients complain of pain in the
morning or after rising from prolonged
sitting, with relief with movement.
A physical examination will reveal pain on
medial plantar calcaneal region, pain with
dorsiflexion”windlass test”, and tightness of
the Achilles tendon or the gastrocnemius
muscle.
as we consider a patient's medical history,
physical activity, foot pain symptoms, and
more.

7. MAKING THE DIAGNOSIS
Plantar fasciitis most often is a clinical
diagnosis
Plain radiographs can rule out bony
lesions or stress fractures
diagnostic Ultrasound can rule out
certain causes of heel pain (such as
plantar fibromatosis, foreign body) and
can aid fascial thickness and the
presence of fascial tears

8. DIAGNOSTIC ULTRASOUND
Several authors have reported the
thickening of the plantar fascia and
hypoechoic changes as characteristic
features of plantar fasciitis. Multiple
studies have verified that in patients
with symptomatic plantar fasciitis, the
plantar fascia thickness tends to be
greater than 4 mm on diagnostic
ultrasound.

9. TREATMENT OPTIONS
Between 70% and 80% of patients have reduced pain with
conservative treatment alone as the normal course is within one
year.
.
• activity modification and relative rest of offending activity
• Ice or topical NSAIDs can be used to help alleviate pain.
• Deep friction massage of the arch and insertion.
• Educate patients on proper stretching and rehab.
• orthotics silicone heel cup or arch supports.
Corticosteroid injections were found to be more effective versus
placebo in pain relief at one month, but these effects were not
sustained over longer period.

13. SURGRY OPTIONS
Consider surgery if the patient has
continued pain after 12 months of
nonsurgical management. Options
include partial or complete plantar fascia
release and gastrocnemius release. These
surgeries may be performed as open or
endoscopically.

14. THANK YOU
ANY QUESTION?