Plantar fasciitis

• 728.71 Plantar fascial fibromatosis

• M72.2 Plantar fascial fibromatosis

• 4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation1

Description

• 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

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

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 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

Functional Implications

• 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

Possible Contributing Causes

• 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

Differential Diagnosis

• 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

Imaging

• X-ray for incidental heel spur7
• Diagnostic ...