Miscellaneous Injuries to the Foot and Ankle (Plantar Fasciitis)

Plantar fasciitis is the most common diagnosis of heel pain. Patients most often complain of heel pain that is worse in the morning or after a long period of sitting, and diagnosis is usually made based on history and physical examination. Radiologic Evaluation: Antero-posterior, lateral, and oblique views in weight-bearing X-rays may reveal calcaneal spur or some other pathology causing the pain. Magnetic nuclear resonance (MRI): It is useful to assess PF thickening or rupture, calcaneal osseous oedema, stress fractures, among others. Treatments should begin conservatively with stretching and can be supplemented with formal physical therapy if needed. Other first-line noninvasive treatments include nonsteroidal anti-inflammatory drugs (NSAIDs) and orthotics. A night splint can be added, though compliance is poor and the cost is relatively high. If symptoms have not improved after these options, injections may be considered. If patients’ symptoms continue to persist for more than 6 months then surgical treatment is recommended. Our technique of choice is total plantar fascia percutaneous release. Surgical release typically is a last resort. The most common complications of fasciotomy are instability of the lateral foot column due to a fall of the plantar arch, which may cause pain in the calcaneocuboid joint or in the tarsal sinus, metatarsalgia, and secondary flat foot. Plantar fasciitis is common but treatable.