This document provides an overview of plantar fasciitis. It begins with an applied anatomy section and defines plantar fasciitis as pain in the heel and bottom of the foot that is worse with first steps in the morning or after periods of rest. A clinical case is presented of a 37-year old obese female with right heel pain for 8 months. Differentials for heel pain are discussed. The document then covers the history, examination, investigations and treatment approaches for plantar fasciitis, emphasizing conservative management options.

1. An Approach
to
Plantar Fasciitis
Prepared by
Manoj Khadka
Intern, Shree Birendra Hospital

2. Presentation outline
• Applied anatomy
• Plantar fasciitis
- Introduction
- Clinical features
- Investigations
- Treatment
• Take home message

6. Clinical scenario
A 37 years old obese female presented to you with a
right heel pain for 8 months?
Differentials for the case?

7. Differentials for heel pain

8. History
Pain - heel
- gradual onset
- dull aching
- non radiating
- associated tightness of Achilles tendon
- worse in early morning
- gradually subsides after few steps
- moderate to severe intensity

9. Heel pain worst early in the morning...

11. Source of pain in plantar fasciitis
• Plantar fascia
• Subcalcaneal bursa
• Fat pad
• Tendinous insertion of intrinsic muscles
• Long plantar ligament
• Medial calcaneal branch of tibial nerve
• Nerve to abductor digiti minimi

12. • Associated with
- seronegative arthropathy
- gout
- peripheral neuropathy (DM)

13. Examination
• Marked tenderness over medial aspect of calcaneal
tuberosity (attachment of plantar fascia)
• Passive stretching of the toes increases pain in the heel
• Ankle dorsiflexion & great toe extension may be decreased

15. Investigations
• Plain X ray (Lateral view)
- Exclude calcaneal stress fracture
- Bony spur on undersurface of calcaneum

16. Treatment

19. Take Home Message
• History
- Heel pain worse in early morning
• Examination
- Marked tenderness over medial aspect of calcaneal
tuberosity
• Conservative management

20. References
• Solomon L, Warwick D, Nayagam S. Apley’s System of
Orthopaedics and Fractures. 9th edition. London: Hodder
Arnold; 2010. 618-619 p.
• Ebnezar J, John R. Textbook of Orthopaedics. 5th edition.
New Delhi: Jaypee; 2017. 428-429 p.
• Maheshwari J, Mhaskar VA. Essential Orthopaedics. 6th
edition. New Delhi: Jaypee; 2019. 304 p.

21. THANK YOU!