Plantar Fasciitis

Plantar fasciitis is the most common cause of plantar heel pain in adults, typically causing sharp inferomedial heel pain with the first steps in the morning or after rest.

It is a degenerative overload condition of the plantar fascia origin on the medial calcaneal tuberosity rather than an inflammatory one, so the terms plantar fasciopathy and plantar heel pain are increasingly used. It is most common between 40 and 60. It is usually self-limiting, but symptoms often last a year or more.

The plantar fascia runs from the medial calcaneal tuberosity to the proximal phalanges and is the main static support of the medial longitudinal arch.

In the windlass mechanism (Hicks), toe dorsiflexion at push-off tightens the fascia around the metatarsal heads and stiffens the arch. Repetitive overload causes microtears at the origin. Histology shows collagen degeneration, disorganised fibres and increased ground substance, with little active inflammation.

Risk factors:

• •Raised body mass index, the most consistent association in systematic reviews, especially in people who are not athletes
• •Reduced ankle dorsiflexion (calf tightness), reported in some studies, though the evidence overall is inconsistent
• •Prolonged standing at work, running and sudden increases in load
• •Foot posture (flat or high-arched foot) and poor footwear
• •Axial spondyloarthritis, through enthesitis