Plantar Fasciitis or Jogger’s Heel is a common painful disorder affecting the heel and underside of the foot. Approximately 10% of people have plantar fasciitis at some point during their lifetime. It is a disorder of the insertion site of the plantar fascia on the heel bone and is characterized by scarring and inflammation. It is often caused by overuse injury of the plantar fascia,sudden increases in exercise, weight, or age. It is also seen more commonly in people with high arched feet. Though plantar fasciitis was originally thought to be an inflammatory process, newer studies have demonstrated structural changes more consistent with a degenerative process. As a result of this new observation, many in the academic community believe that the condition should be renamed plantar fasciosis.
The heel pain characteristic of plantar fasciitis is usually felt on the bottom of the heel and is most intense with the first steps of the day. Individuals with plantar fasciitis often have difficulty with dorsiflexion of the foot, an action in which the foot is brought toward the shin. This difficulty is usually due to tightness of the calf muscle or Achilles tendon, the latter of which is connected to the back of the plantar fascia.Most cases of plantar fasciitis resolve on their own with time and respond well to conservative methods of treatment.
Originally, plantar fasciitis was believed to be an inflammatory condition of the plantar fascia. However, within the last decade, studies have observed microscopic anatomical changes indicating that plantar fasciitis is actually due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process. Due to this shift in thought about the underlying mechanisms in plantar fasciitis, many in the academic community have stated the condition should be renamed plantar fasciosis. The structural breakdown of the plantar fascia is believed to be the result of repetitive micro trauma (small tears). Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and disorganized collagen fibers.
The diagnosis is essentially clinical with no real need for any radiological imaging.An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus (heel bone), which can be found in up to 50% of those with plantar fasciitis. In such cases, it is the underlying plantar fasciitis that produces the heel pain, and not the spur itself. The condition is responsible for the creation of the spur though the clinical significance of heel spurs in plantar fasciitis remains unclear.
About 90% of plantar fasciitis cases are self-limiting and will improve within six months with conservative treatment and within a year regardless of treatment. Many treatments have been proposed for the treatment of plantar fasciitis. First-line conservative approaches include rest, heat, ice, calf-strengthening exercises, techniques to stretch the calf muscles, Achilles tendon, and plantar fascia, weight reduction in the overweight or obese, and nonsteroidal anti-inflammatory drugs (NSAIDs) .
Plantar Fasciotomy is often considered after conservative treatment has failed to resolve the issue after six months and is viewed as a last resort .Minimally invasive and endoscopic approaches to plantar fasciotomy exist but require a specialist who is familiar with certain equipment. A study found 76% of patients who underwent endoscopic plantar fasciotomy had complete relief of their symptoms and had few complications (level IV evidence). Heel spur removal during plantar fasciotomy has not been found to improve the surgical outcome.