What is Plantar Fasciitis (Heel Spur)?
Plantar fasciitis is the most common cause of chronic heel pain in adults and affects both young active patients and older sedentary individuals. It is caused by repetitive stress of the plantar fascia at the beginning of the medial tubercle of the calcaneus and is often associated with gastrocnemius strain.
What are the Causes of Plantar Fasciitis (Heel Spur)?
It may be due to overuse, as seen in runners and military personnel, or it may be due to overload, as seen in overweight, sedentary individuals and those who stand for long periods of time. It is also more common in individuals with structural foot deformities. It is mostly unilateral, but in one-third of patients it is bilateral.
What are the Symptoms of Plantar Fasciitis (Heel Spur)?
The most common symptom is painful plantar heel pain, which is worst when taking the first step in the morning or after periods of rest.
How is Plantar Fasciitis (Heel Spur) Diagnosed?
The diagnosis is confirmed by pinpoint tenderness at the beginning of the plantar fascia of the medial tubercle of the calcaneus. Its origin in the plantar fascia and calcaneus should be palpated to reveal tenderness. The range of motion of the ankle should be evaluated with the knee in flexion and extension. Less than 10 degrees of dorsiflexion with the knee in extension or more than 10 degrees of difference between dorsiflexion in knee flexion and extension are signs of gastrocnemius equinus (i.e., a positive Silverskiold test).
In x-ray examination; Heel spur (spur-shaped bony prominence) is a symptom of calcification at the origin of the flexor digitorum brevis muscle, which develops in response to chronic tension of the heel cord.
Ultrasound and MRI examinations are also used to evaluate soft tissues.
EMG helps localize the location of pain if nerve entrapment is suspected.
What is Plantar Fasciitis (Heel Spur) Treatment?
It is usually a self-limiting condition; More than 90% of patients achieve symptomatic improvement with 3-6 months of conservative treatment. Initial treatment consists of activity modification, anti-inflammatory medication, stretching of the gastrocnemius and plantar fascia, and an in-shoe orthosis that elevates and cushions the heel.
Patients who remain symptomatic despite a 6-month trial of nonoperative treatment may be considered for minimally invasive treatment or surgery. Platelet-rich plasma injections and therapeutic ultrasound are among a number of minimally invasive treatments that stimulate the body’s healing response. Corticosteroid injections temporarily relieve pain but may increase the risk of plantar fascia tears and fat pad atrophy. Botulinum toxin injections relax the calf muscles, reducing stress on the plantar fascia.
Operative treatments include gastrocnemius recession, which reduces stress on the plantar fascia, and partial plantar fasciotomy, which stimulates the release of the medial gastrocnemius head and the healing response.