The plantar fasciitis or plantar fasciitis is inflammation of the plantar fascia. The plantar fascia is a thick band of fibrous tissue that extends from the heel bone to the toes. This band is covered in fat to absorb shocks and supports the plantar arch (see pictures).
Plantar fasciitis is the most often cause of heel pain, affecting between 3.6 and 7.0% of the population. It often occurs between ages of 40 to 60, affecting females (females) and males (males) in the same way.
Plantar fasciitis is in most cases unilateral, affecting both the left and right heels. Bilateral plantar fasciitis that is that affects both feet simultaneously is less frequent, occurring in about one-third of the cases.
Concerning the duration of symptomatology, it is important to point out that ignoring plantar fasciitis in its acute phase can lead to chronic pain.
Plantar fasciitis – causes
Although the causes of plantar fasciitis are not completely understood, it is known that there are some risk factors for the development of the disease, namely:
- Obesity (overweight) – body mass index (BMI) greater than 30;
- Sports activity on the go (running, jumping, ballet and dancing), or when people remain for long periods of standing;
- Foot cavus / flat foot / anomalous gait patterns;
- Decreased dorsiflexion of the ankle (less than 0º);
- Retraction of the gastrocnemius-soleus and hamstring muscles;
- Secondary to systemic inflammatory diseases.
It is controversial that the presence of spur of the calcaneus contributes to the symptomatology. It should be noted that between 11 and 46% of patients with calcaneal spurs are asymptomatic, and in 32% of patients with plantar fasciitis, there is no presence of the calcaneal spur.
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Plantar Fasciitis – Symptoms
In plantar fasciitis, the main symptom is the heel pain, often described as “pricking.” The pain typically has an insidious onset and no irradiation, often getting out of bed in the morning and tending to relieve after taking the first few steps. The pain tends to worsen when climbing stairs or if the patient remains standing for some time.
The pain tends to alleviate with ambulation (walking, walking) and aggravates with prolonged rest. Usually, the pains worsen at the end of the day with prolonged orthostatic.
In some cases, some edema (“swelling”) of the heel and ankle may occur.
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Plantar fasciitis – diagnosis
The diagnosis of plantar fasciitis will perform by the orthopedic doctor based on the clinical history and reporting, in some cases, to some diagnostic or therapeutic aids (MCDT), namely:
Radiography (RX) of the foot. –It’s useful to confirm the diagnosis if carried out in load allows excluding other (degenerative) pathologies;
Magnetic resonance imaging (MRI) - It is rarely used in the diagnosis. However, this examination may be necessary to exclude other pathologies (fracture of calcaneus stress). The NMR is a test that, if needed, can be used to perform the surgical planning.
Bone scintigraphy - This is an examination that helps to quantify the inflammation. It can be conducted to exclude other pathologies (e.g., calcaneus stress fracture);
Analytical Study - Although not used routinely, it can be useful to rule out other diseases (inflammatory arthritis, infection, etc.).
Electromyography - Electromyography can be used to exclude nerve compression.
In the differential diagnosis, the following pathologies must be taken into account:
- Calcaneal fat atrophy;
- Tarsal tunnel syndrome;
- Calcaneal stress fracture;
- Baxter’s neuropathy (compression of the first lateral plantar nerve branch);
- Posterior tibial tendon dysfunction;