Description:
- Microtrauma to plantar fascia near its attachments leading to attempted repair and chronic inflammation
- The most common cause of heel pain
- May be associated with a calcaneal spur
- No clear single etiology for pain
- No single treatment
- Common in runners and dancers
Symptoms:
- Calcaneodynia (heel pain)
- “First step pain” in morning
- Pain along plantar, medial aspect of heel
- Pain may extend distally toward metatarsal heads
- Pain worsens with dorsiflexion of toes
Treatment:
- Conservative, nonsurgical is the mainstay of treatment, including:
- Heel cord stretching regimen
- Anti-inflammatory medications
- Heel cushioning
- Orthotic insert under longitudinal arch of foot if flat foot present
- Corticosteroid injection (right)
- Night splint tmaintain neutral position of ankle tprevent Achilles tendon shortenong overnight
- Absolute rest – casting
- Over 80% of patients respond tconservative management
Surgical therapy:
- If nimprovement after 1 year of conservative treatment:
- Excision of plantar heel spur,
- if present
- Release of plantar fascia