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  • 728.71 Plantar fascial fibromatosis

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  • M72.2 Plantar fascial fibromatosis

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Description

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  • Inflammation of fascia on bottom of the foot or at the insertion of the medial calcaneal tubercle
  • Overstretching of the fascia can occur via two processes
    • Acute inflammatory process
      • Usually with pes cavus (high arch) foot type2
      • Rapid overstretch possible from missing a step or curb
      • May be caused by trauma, as in stepping on hard object or ledge
    • Chronic inflammatory process
      • Usually with a pes planus (flat foot, low arch) foot type2
      • Chronic overstretching of the fascia or ligamentous support
      • Degenerative tendinosis of the foot’s intrinsic flexors and invertors

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Essentials of Diagnosis

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  • Diagnosis usually made by clinical examination3
  • Can be an independent diagnosis, not associated with a disease process
  • May not be fasciitis, but inflamed flexor digitorum brevis or tibialis posterior4
    • May feel better once warmed up
    • Fatigues gradually throughout the day

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General Considerations

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  • Most common orthopedic foot complaint

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Demographics

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  • Most common in middle age
  • Men and women equally affected
    • Distance running
    • Poor footwear
    • Weight gain, pregnancy
    • Prolonged standing on hard floors, including cement, tile, hardwood

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Signs and Symptoms

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  • Stabbing pain in heel with
    • First step of the day5
    • First step out of a chair
    • Barefoot walking on a hard surface
  • Burning sensation underneath mid arch indicates tibial nerve entrapment3,5
  • Heel pain with palpation at origin of the fascia where heel spur can occur5
  • Aching, fatigue, soreness as day progresses may indicate inflamed flexor digitorum brevis or tibialis posterior5,6
  • Mild swelling along bottom of feet5

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Functional Implications

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  • Pain with standing; limitation on standing in one spot
  • Pain along bottom of foot and heel with ambulation
  • Balance and instability due to altered gait and stance patterns

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Possible Contributing Causes

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  • Pes planus (flat feet) foot type can cause chronic elongation of the fascia
  • Pes cavus rigid foot type with acute strain
  • Rearfoot and forefoot varus
  • Occupation that demands
    • Prolonged standing
    • Steel-toed shoes
    • Shoes with no arch support
    • Standing on hard surfaces
  • Sudden weight gain that overloads muscular system
  • Pregnancy
    • Ligamentous laxity (hormone relaxin)
    • Excessive weight gain
    • Decreased arch height
    • Barefoot
  • Obesity
  • Limited dorsiflexion (tight heel cord)
  • Lack of talocrural joint mobility
  • Jogging or running on cement

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Differential Diagnosis

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  • Heel spur
  • Heel pain
  • Tibial nerve entrapment
  • Flexor digitorum brevis tendonitis
  • Tibialis posterior tendonitis
  • S1 radiculopathy
  • Reiter’s syndrome
  • Metatarsalgia
  • Tarsal tunnel syndrome
  • Metatarsal stress fracture

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Imaging

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