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212: PLANTAR FASCIITIS

Eric Shamus, PhD, DPT, PT, CSCS; Jennifer Shamus, PhD, DPT, COMT, CSCS

CONDITION/DISORDER SYNONYMS

  • Plantar fascial fibromatosis

  • Plantar fasciopathy

ICD-9-CM CODE

  • 728.71 Plantar fascial fibromatosis

ICD-10-CM CODE

  • M72.2 Plantar fascial fibromatosis

PREFERRED PRACTICE PATTERN

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation1

PATIENT PRESENTATION

Patient reports gradual worsening of heel pain. It is worst with first step of the day and after prolonged sitting. The pain feels better after 2 to 3 minutes of walking. Pain also increases at the end of the day after she has been on her feet at work. Patient states no radicular leg symptoms. When asked, patient states she likes to walk barefoot at home on the tile floors. Patient has had 2 injections into the heel with pain returning. The patient has tried a night splint and continues to have pain.

KEY FEATURES

Description

  • Inflammation of fascia on bottom of the foot or at the insertion of the medial calcaneal tubercule

  • 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

Essentials of Diagnosis

  • 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

General Considerations

  • Most common orthopedic foot complaint

Demographics

  • 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

FIGURE 212-1

(A) Plantar fascia taping technique. (B) Heel pad for treating plantar fasciitis. (C) Plantar fascia arch support padding. (D) Stretches for plantar fasciitis. (From Simon RR, Sherman SC. Emergency Orthopedics. 6th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • 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 ...

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