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plantar fasciitisHeel spur syndrome Orthopedics The most common cause of inferior heel pain, usually of the medial aspect of the plantar fascia as it attaches to the inferior medical calcaneal tuberosity; the pain is usually worse in the morning and persists as a dull, toothache-like pain, exacerbated by ↑ activity, lasting up to 6-12 months; the medial insertion of the plantar fascia on the calcaneus may be tender; extension of the great toe can cause Sx; cavus feet or pronation on gait may be evident on exam Management Cross-friction ice massage, arch exercises, stretches, heel cups, NSAIDs, arch pads/orthotics, night splints, physical therapy
plan·tar fas·ci·i·tis(plan'tahr fash'ē-ī'tis)
plantar fasciitisAn inflammatory disorder of the strong sheet of white fibres under the shin of the sole of the foot that helps to maintain the longitudinal arch. Plantar fasciitis may be caused by unaccustomed athletic activity, sudden weigh gain or unsuitable footwear. It is the commonest cause of pain under the heel but will usually resolve without treatment.
fasciitisinflammation of fascia
plantar fasciitis acute or chronic inflammation of plantar fascia due to formation of microtears in response to repetitive excessive tensile forces (e.g. as in overpronating or cavoid foot); characterized by pain, acute or chronic discomfort in proximal, central or distal part of the plantar fascia, that may radiate into the Achilles tendon; see triple therapy for plantar fasciitis; Table 1
|Location of pain||Possible causes|
|Posterior aspect of heel||Sever's disease/traction apophysitis|
Duck bill fracture of calcaneum
Insertional calcific Achilles tendinosis
Deep retrocalcaneal bursitis
Superficial retrocalcaneal bursitis
Partial rupture of Achilles tendon
Total rupture of the Achilles tendon
|Inferior (plantar) aspect of heel||Calcaneal fracture|
Sero-negative and sero-positive inflammatory joint disease
Plantar calcaneal bursitis (policeman's heel; stone bruise; subcalcaneal bursitis)
Proximal plantar fasciitis
Proximal foot strain
S1 entrapment neuropathy/radiculopathy
Medial calcaneal nerve entrapment neuropathy
|Medial aspect of the heel||Deltoid ligament strain/sprain|
Tibialis posterior tendinitis
Tibialis posterior rupture/partial rupture
Flexor hallucis longus tendinitis
Flexor digitorum longus tendinitis
|Lateral aspect of the heel||Lateral collateral ligament strain/sprain|
Peroneus longus tendinitis
Peroneus brevis tendinitis
|Anterior aspect of ankle||Osteochondritis dissecans of the talus|
|Periphery of heel||Heel fissures|
Patient discussion about plantar fasciitis
Q. Can anyone suggest a treatment for plantar fasciitis, apart from ultrasound, physio, anti-inflammatory agents? My friend has had Plantar Fasciitis for more than 1 year and has persevered with all the ususal treatments above plus lots of rest from weight-bearing and elevation.
More advanced treatments include steroid-local anesthetics injections, botulinum toxin (similar to botox) injections and surgery.
The prognosis is usually favorable, and most patients achieve relief of the pain.
However, all of the above is just for general knowledge - if you have any specific question, you may want to consult a doctor.
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Q. Is there any good source for heel pain relief, besides NSAIDs? My heel pain is most severe at night when I sleep. It's as if the way I position my feet worsen the condition, but I'm at a loss to know how to position my feet. During the day my heels feel so but don't typically bother me.