This document discusses plantar fasciitis, a painful inflammatory condition of the plantar fascia in the sole of the foot. It defines plantar fasciitis and discusses its common causes such as deterioration or trauma to the plantar fascia. It also outlines the epidemiology, anatomy, biomechanics, pathology, symptoms, diagnostic assessments including imaging, differential diagnosis, and management approaches for plantar fasciitis such as physical therapy, orthotics, night splints, stretching, modalities, and surgery.

1. Plantar Fasciitis

2. Plantar Fasciitis
It is also referred to as plantar
heel pain syndrome, heel spur
syndrome, or painful heel
syndrome.
It is an overload injury usually associated
with biomechanical abnormalities

3. Definition
It is a painful inflammatory
process of the plantar fascia, the
connective tissue or ligament on
the sole of the foot.

4. Etiology
Deterioration of the plantar fascia.
Mechanical overload of the plantar
fascia
Damaged by direct impact or
repetitive trauma
Damage to other supporting
structures

5. Epidemiology
most common cause of pain in the
inferior heel
Estimated to account for 11 to 15 %
of all foot symptoms requiring
professional care among adults.
affects 15-20% of runners

6. Epidemiology
common among military personnel.
ages of 40 and 60 years in the
general population
Women>Men
65% non-sports demographics are
over-weight
70% unilat. involvement

7. Anatomy

8. pass
Deep Fascia
 Triangular thickening of the
fascia that protects the under
nerves, blood vessels, and
Apex: medial and lateral
the calcaneum.
Base: divides into five
into the toes.

9. Deep Fascia
Have indirect relationship with
Achilles Tendon, if toes are
dorsiflexed plantar fascia tightens
via WINDLASS MECHANISM

10. Muscles & ligaments of the Sole of the
Foot

11. Biomechanics of Plantar
fascia

12. Biomechanics of Plantar Fascia
It contributes to support of arch of the
foot by acting as a tie-rod, where it
undergoes tension when the foot bears
weight.
It carries as much as 14% of the total
load of the foot.

13. Biomechanics of Plantar fascia
Complete rupture or surgical release of the
plantar fascia
Leads to a ↓ in arch stiffness and a
significant collapse of the longitudinal arch
of the foot.
↑ both stress in the plantar ligaments and
plantar pressures under the metatarsal
heads.

14. Biomechanics of Plantar Fascia
Has an important role in dynamic
function during gait.
Continuously elongated during the
contact phase of gait.
Reaches a maximum of 9% to 12%
elongation between mid-stance and
toe-off.
Plantar fascia behaves like a spring.

15. Biomechanics of Plantar fascia
The plantar fascia has a critical role in
normal mechanical function of the foot,
contributing to the "windlass
mechanism".

16. Pathology

17. Pathology
The site of abnormality is typically
near the site of origin of the plantar
fascia at the medial tuberosity of the
calcaneus.
It is more likely caused by
degeneration or weakening of the
tissue.

18. Pathology
This process probably begins with small
tears that occur during activity and that,
in normal circumstances, the body simply
repairs, strengthening the tissue as it
does.
The small tears don’t heal. They
accumulate

19. COMPLAINTS
Pain under the heel
Severe pain &
inability to walk in
morning after
getting from sleep
Same pain in heel
after sitting for
long time and
getting up to walk
Pain gets better
after taking few
steps
Worsening pain
after prolonged
standing/walking

20. Examination & Diagnostic
Procedures

21. Special Investigations:
• Aim
 Confirm the diagnosis
• Modalities Available
 Plain x-rays of feet
 Ultrasound
 MRI

22. • Plain X-Rays of Feet
 Generally unhelpful
 Rule out stress fractures of calcaneus
 Calcifications noticed + osteophytes (heel spurs)
Study: osteophytes visible
50% with plantar fasciitis,
19% without plantar fasciitis12
Special Investigations:

23. • Ultrasound
 Useful
 Non-invasive technique
 Increased thickness + hypo-echoic fascia
Special Investigations:

24. • Magnetic Resonance Imaging (MRI)
 Thickening of the plantar fascia
 Detecting tears or rupture of the fascia
Special Investigations:

25. Differential Diagnosis

27. Management

29. Pharmacology
NSAIDs medication
Cortisone injections.

30. Physical Therapy
More than 90% of patients with
plantar fasciitis will improve within
10 months of starting simple
treatment methods.

31. General Measures
Rest
Ice
(20 min; 3-4x/day)

32. Manual Therapy
 Talocrural joint posterior glide
 Subtalar joint lateral glide
 Anterior and posterior glides of 1st
tarsometatarsal joint
 Subtalar joint distraction manipulation

33. Taping
Calcaneal taping
or low-dye taping
used for short-
term pain relief.
Taping does
cause
improvement in
function.

34. Shoe Inserts

35. Night Splints

36. Stretching

37. Modalities
Therapeutic ultrasound
Extracorporeal shockwave therapy
(ESWT).

38. ELECTROTHERAPY

39. Massage
Deep tissue Massage
MFR

40. Operative Treatment
• Recommended Procedures Include
(1)Elevation of the entire heel pad through a horseshoe incision
around the hindfoot, with release of all soft tissue origins from the
anterior aspect of the calcaneal tuberosity
(2)Neurolysis of a single nerve
(3)Osteotomy of the calcaneus
(4)Excision of the medial inferior tuberosity of the calcaneus
(5)Simple drilling of multiple

42. Resection of small medial portion of plantar fascia
Resect a 2 to 3 × 4-mm rectangle of medial plantar fascia.
An entire plantar fasciotomy may be performed in
some Nonathletic patients who have pain throughout the entire insertion
of the plantar fascia medially and laterally.

43. • If a large spur is present preoperatively and is
thought to contribute to symptoms,
Resect the Spur by gently reflecting the
flexor digitorum brevis off the exostosis.
•Take care not to damage the first branch of the lateral
plantar nerve that lies just superior to the spur.

44. • Endoscopy for Plantar Fascia Release
Based on limited release of the central cord of the fascia.
– An effective procedure with reproducible results, a low
complication rate, and little risk of iatrogenic nerve injury.

45. POSTOPERATIVE CARE
• Non–weight bearing for 2 weeks after surgery.
• The sutures are then removed
• Gradual weight bearing to tolerance is begun.
• Resumption of heel cord stretching and
increased activity are encouraged.