eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Plantar Fasciitis

Author: Deepika Singh, MD, Staff Physician, Department of Emergency Medicine, Brown University
Coauthor(s): Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn; Leslie Milne, MD, Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine
Contributor Information and Disclosures

Updated: Oct 2, 2008

Introduction

Background

Plantar fasciitis is the most common cause of heel pain for which professional care is sought. A variety of terms have been used to describe it including jogger's heel, tennis heel, Policeman's heel, and an outdated term, gonorrheal heel reflecting the old thought that it was somehow related to that sexually transmitted disease.

Pathophysiology

The plantar fascia originates on the medial tubercle of the calcaneus and fans out over the bottom of the foot to insert onto the proximal phalanges and the flexor tendon sheaths. It forms the longitudinal arch of the foot and functions as a shock-absorber as well an arch support. The term fasciitis may be somewhat of a misnomer since the disease is actually a degenerative process with or without inflammatory changes, which may include fibroblastic proliferation. This has been proven from biopsies of fascia from people undergoing surgery for plantar fascia release. It is commonly believed to be caused by repetitive microtrauma to the fascia.

Frequency

United States

Plantar fasciitis accounts for about 10% of runner-related injuries and 11-15% of all foot symptoms requiring professional care. It is thought to occur in 10% of the general population as well. It may present bilaterally in a third of cases.

Mortality/Morbidity

Plantar fascitis probably may lead to significant morbidity placing strict activity limitations on the patient. In addition, due to the pain in the foot leading to changes in patterns of bearing weight, associated additional injury to the hip and knee joints may also occur.

Race

Race and ethnicity play no role in the incidence of plantar fasciitis.

Sex

The condition occurs equally in both sexes in young people. Some studies show a peak incidence may occur in women aged 40-60 years.

Age

The condition can occur at any age. As mentioned, a peak incidence may occur in women aged 40-60 years.

Clinical

History

  • The patient reports inferior heel pain with the first few steps taken in the morning or after other long periods of nonweightbearing.
  • A limp may be present, and patients may prefer to walk on their toes.
  • Initially, the pain decreases with ambulation but then increases throughout the day as activity increases. Pain is worsened by walking barefoot on hard surfaces or by walking up stairs.
  • Associated paresthesias, nocturnal pain, or systemic symptoms should raise suspicion of other causes of heel pain (ie, neoplastic, infectious, neurologic causes).
  • Patients may report that before the onset of pain, they had increased the amount or intensity of activity including, but not limited to, running or walking. They may have also started exercising on a different type of surface, or they may have recently changed footwear.

Physical

  • The patient may have tenderness upon palpation of the anteromedial aspect of the heel.
  • Ankle dorsiflexion may be limited due to tightness of the Achilles tendon.
  • Pain may be exacerbated by passive dorsiflexion of the toes or by having the patient stand on his or her toes.

Causes

  • The cause of plantar fasciitis is unclear and may be multifactorial. Because of the high incidence in runners, it is best postulated to be caused by repetitive microtrauma. Possible risk factors include obesity, occupations requiring prolonged standing, heel spurs, pes planus (excessive pronation of the foot), and reduced dorsiflexion of the ankle.

More on Plantar Fasciitis

Overview: Plantar Fasciitis
Differential Diagnoses & Workup: Plantar Fasciitis
Treatment & Medication: Plantar Fasciitis
Follow-up: Plantar Fasciitis
Multimedia: Plantar Fasciitis
References
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References

  1. Lee TG, Ahmad TS. Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis. A prospective, randomized, controlled trial. Foot Ankle Int. Sep 2007;28(9):984-90. [Medline].

  2. Rompe JD, Furia J, Weil L, Maffulli N. Shock wave therapy for chronic plantar fasciopathy. Br Med Bull. 2007;81-82:183-208. [Medline].

  3. Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord. Apr 19 2007;8:36. [Medline].

  4. Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2003;CD000416. [Medline].

  5. DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. Jul 2003;85-A(7):1270-7. [Medline].

  6. Atkins D, Crawford F, Edwards J, Lambert M. A systematic review of treatments for the painful heel. Rheumatology (Oxford). Oct 1999;38(10):968-73. [Medline].

  7. Buchbinder R. Clinical practice. Plantar fasciitis. N Engl J Med. May 20 2004;350(21):2159-66. [Medline].

  8. Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician. Dec 1 2005;72(11):2237-42. [Medline].

  9. Hogan KA, Webb D, Shereff M. Endoscopic plantar fascia release. Foot Ankle Int. Dec 2004;25(12):875-81. [Medline].

  10. Roxas M. Plantar fasciitis: diagnosis and therapeutic considerations. Altern Med Rev. Jun 2005;10(2):83-93. [Medline].

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Further Reading

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Keywords

plantar fasciitis, jogger's heel, tennis heel, bone spur, heel pain, pain on bottom of heel, exostosis, flat foot, highly-arched foot, excessively pronated foot, gait alteration, obesity, tight Achilles tendon,policeman's heel, pes planus, pes cavus

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Contributor Information and Disclosures

Author

Deepika Singh, MD, Staff Physician, Department of Emergency Medicine, Brown University
Deepika Singh, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Nurses Association, Emergency Medicine Residents Association, and Sigma Theta Tau International
Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Leslie Milne, MD, Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine
Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine
Disclosure: Nothing to disclose.

Medical Editor

Miguel C Fernández, MD, FAAEM, FACEP, FACMT, Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio
Miguel C Fernández, MD, FAAEM, FACEP, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital, Manhattan
Eric Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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