Plantar Fasciitis

Plantar heel pain is a common foot disorder affecting people across all ages and activity levels. The most common etiology of plantar heel pain is plantar fasciitis, accounting for nearly 80% of cases. Plantar fasciitis is characterized by pain on the inferomedial aspect of the calcaneus. The pain is usually worst when taking the first steps in the morning and when getting up after rest. In most cases, it slowly subsides with activity becoming a dull ache but worsens as the activity becomes prolonged. Plantar fasciitis is commonly referred to as an overuse injury caused by biomechanical dysfunctions and repetitive overload on the plantar fascia. Stress on the fascia leads to an acute inflammatory reaction, persistence of the mechanical stimulus over time leads to degenerative changes in the fascial tissue similar to those reported in chronic tendinopathies. Risk factors for plantar fasciitis in the general population are an increased BMI, decreased ankle dorsiflexion, occupations that involve prolonged standing and weight-bearing as well as age, with a peak in prevalence between 40 and 60 years. Plantar fasciitis is also a common pathology among athletes, especially those involved with sports that require running and jumping. The diagnosis of plantar fasciitis is mainly reliant on clinical examination and medical history. Instrumental exams can be helpful in the differential diagnosis with other causes of heel pain. Plantar fasciitis is usually a self-limiting condition and conservative treatment yields favorable results in the overwhelming majority of patients. Surgical treatment represents a last resort in patients with plantar fasciitis and should be attempted only after 6–12 months of failed conservative treatment. Outcomes of plantar fasciitis are generally favorable, and a proper nonsurgical approach can lead to complete remission in almost 90% of patients.