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PLANTAR FASCIITIS                                               KANDILNOTES

INTRODUCTION​

  • Plantar fasciitis is the most common cause of plantar heel pain

  • It is characterized by inflammation of the origin of the plantar fascia and surrounding perifascial structures in the inside of the heel/foot

  • The word fasciitis implies an inflammatory process; however, histologic evidence does not support this concept and suggests more of a degenerative process without inflammation 

  • 80% of heel pain is plantar fasciitis

CAUSES​

  • Although not clearly defined, it is thought to be secondary to repetitive microtrauma at the origin of the plantar fascia

SIGNS AND SYMPTOMS

  • Pain in the sole of the heel and inside of the foot

  • Tenderness of the sole of the foot

  • Pain is often worse with first few steps in the morning and also worse with continued weight bearing

TREATMENT​​

  • Treatment of plantar fasciitis is usually multimodal and involves trying multiple different modalities 

  • The first line of treatment usually a period of rest and can involve a course of physical therapy or a home exercise program focused on stretching of the achilles tendon and plantar fascia

  • Anti-inflammatories such as ibuprofen are oftentimes helpful as an adjunct to other treatments

  • Night splints

  • Custom and over the counter orthotics and heel cups have been shown to help

  • Shockwave therapy has shown good results in some studies

  • Steroid injections are not recommended due to risk of achilles rupture 

  • Plantar fasciitis that has failed conservative management may be treated with Platelet Rich Plasma (PRP) as there is growing evidence that this may help improve pain and avoid surgery 

  • Surgery is reserved for cases that don’t improve after a minimum 6 month course of conservative management if symptoms are significantly affecting activities of daily living and quality of life. 

PREVENTION  â€‹â€‹

  • The best way to prevent this condition is to avoid repetitive activities that overload the achilles tendon and plantar fascia

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