Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Plantar Fasciitis

SYMPTOMS

There is increasing sharp or aching localised pain around the insertion of the plantar fascia at the anterior inferior part of the calcaneus, without preceding trauma. This condition commonly occurs in middle-aged athletes who run or jump repeatedly on the forefoot but is also common in manual orkers who stand on hard surfaces in poor shoes.

AETIOLOGY

The aetiology is unclear but in the literature a chronic inflammatory process from overuse/ stress to the insertion is often suggested. Strangely, when biopsies are taken from operated fasciitis there are no inflammatory cells. The name of this condition could thus be challenged.

CLINICAL FINDINGS

There is intense localised tenderness on palpation over the insertion, which is aggravated on extension of the plantar fascia by dorsi-flexion of the ankle and the toe extensors.

INVESTIGATIONS

X-ray often shows a bony spur in chronic cases, which is not correlated to the symptoms but rather indicates a chronic reaction caused by repetitive strain to the insertion.

TREATMENT

Initially try orthotics to support the foot arch, which provides improved shock absorption/ padding of the insertion area combined with stretching of the plantar fascia. NSAID or local cortisone injections can give short-term relief. Surgery is seldom indicated.

REFERRALS

Refer to podiatrist and physio – therapist for mild symptoms and sports physician if the symptoms are severe.

EXERCISE PRESCRIPTION

Rest will not help so allow all kinds of sporting activities, with wellfitting shoes. If there is pain on impact, suggest low-impact alternatives such as cycling and swimming.

EVALUATION OF TREATMENT OUTCOMES

Monitor the decrease of clinical symptoms and signs. Symptoms can last for one to two years.

DIFFERENTIAL DIAGNOSES

A plantar fascia rupture can give the same symptoms and occur on the same location but with sudden onset and collapse of the foot arch. Ultrasound or MRI can help to differentiate. This condition occurs either while
landing from a jump or in a running stride and is often associated with a previous cortisone injection for plantar fasciitis. Tarsal tunnel syndrome can cause radiating pain from nerve branches below the medial malleoli towards the insertion of the plantar fascia. Often the Tinel’s sign is positive and local naesthetic injected around the Tarsal tunnel (not the plantar fascia insertion) immediately relieves symptoms.

PROGNOSIS

Excellent but with long duration of symptoms.

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