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Information about Plantar Fasciitis

Plantar fasciitis
Classification & external resources
Areas of pain caused by inflammation of the plantar fascia which connects the area of the foot near the toes with the heel. Pain usually occurs at its attachment into the heel bone (calcaneus, panel A)
ICD-10M72.2
ICD-9728.71
DiseasesDB10114
MedlinePlus007021
eMedicineorthoped/142 


Plantar fasciitis, formerly known as "policeman's heel", is a painful inflammatory condition caused by excessive wear to the plantar fascia of the foot or biomechanical faults that cause abnormal pronation of the foot.[1] The pain usually is felt on the underside of the heel, and is often most intense with the first steps of the day. It is commonly associated with long periods of weight bearing. Obesity, weight gain, jobs that require a lot of walking on hard surfaces, shoes with little or no arch support, and inactivity are also associated with the condition. This condition often results in a heel spur on the calcaneus, in which case it is the underlying condition, and not the spur itself, which produces the pain.[1]

Treatment

Many different treatments have been effective, and although it typically takes six to eighteen months to find a favorable resolution,[3] plantar fasciitis has a generally good long-term prognosis. The mainstays of treatment are stretching the Achilles tendon and plantar fascia, resting, keeping off the foot as much as possible, discontinuing aggravating activity, cold compression therapy, contrast bath therapy, weight loss, arch support and heel lifts, and taping. To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of very limited benefit.[4] One small, placebo-controlled study has shown a beneficial effect from glucosamine.[5]

Care should be taken to wear supportive and stable shoes. Patients should avoid open-back shoes, sandals, and flip-flops.

Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, if not combined with a local anesthetic and injected slowly with a small-diameter needle.[6] Recurrence rates may be lower if injection is performed under ultrasound guidance.[7]

In cases of chronic plantar fasciitis of at least 10 months duration, one recent study has shown high success rates with a stretch of the plantar fascia.[8]<ref name"Digiovanni"=>Digiovanni BF, Nawoczenski DA, Malay DP, Graci PA, Williams TT, Wilding GE, Baumhauer JF (2006). "Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up". The Journal of bone and joint surgery. American volume 88 (8): 1775-81. PMID 16882901. 

Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease morning pain. Pain with first steps of the day can be markedly reduced by stretching the Achilles tendon before getting out of bed. Patients should be encouraged to lessen activities which place more pressure on the balls of the feet. Over-the-counter arch support may help, and prescription orthoses are often prescribed. These can be made of many different materials, some of which may be hard and may press on the origin of the plantar fascia. Softer, custom devices, of plastizote, poron, or leather, may be more helpful. Orthoses should always be broken in slowly.

Therapeutic ultrasound has been shown in a controlled study to be ineffective as a treatment for plantar fasciitis.[9] More recently, however, extracorporeal shockwave therapy (ESWT) has been used with some success in patients with symptoms lasting more than 6 months.[10] The treatment is a nonsurgical procedure, but must be done either under local anaesthesia either with or without intravenous sedation (twilight sedation). The basic premise behind ESWT is that in chronic pain (over six months) the brain no longer perceives the pain (even though the patient feels pain) and so no longer is sending signals to fight the pain. ESWT basically re-inflames the area and in doing so increases blood flow to the area as a means to heal the area. It can take as long as six months following the procedure to see results. Like any procedure there are varying degrees of success.[11]

Surgery

Surgical procedures, such as plantar fascia release, are a last resort, and often lead to further complications such as a lowering of the arch and pain in the supero-lateral side of the foot due to compression of the cuboid bone. Recent research has indicated that an ultrasound guided needle fasciotomy is the most effective surgical intervention for Plantar Fasciitis. This is a minimally invasive procedure where a needle is inserted into the Plantar Fascia and moved back and forwards to disrupt the fibrous tissue that proliferates as a result of the chronic inflammation.

Alternative treatments

Plantar fasciitis and other forms of foot pain are sometimes treated in acupuncture clinics.[12] Although there are no large research studies, one case series on the use of electroacupuncture for treating plantar fasciitis in eleven patients found that nine reported greater than 50% reduction in pain.[13]

References

1. ^ Barrett SJ, O'Malley R (1999). "Plantar fasciitis and other causes of heel pain". American family physician 59 (8): 2200-6. PMID 10221305. 
2. ^ Barrett SJ, O'Malley R (1999). "Plantar fasciitis and other causes of heel pain". American family physician 59 (8): 2200-6. PMID 10221305. 
3. ^ Young, Craig C., Rutherford, Darin S. & Niedfeldt, Mark W. (2001). "Treatment of Plantar Fasciitis". American Family Physician 63 (3): 467-74,477-8. 
4. ^ Lynch, D., Goforth, W., Martin, J., Odom, R., Preece, C., & Kottor M. (1998). "Conservative treatment of plantar fasciitis. A prospective study". Journal of the American Podiatric Medical Association 88 (8): 375–380. PMID 9735623. 
5. ^ Jeannine Stein. "Special Fitness Issue: The Foot" (Abstract), Los Angeles Times, January 1, 2007, pp. F9. 
6. ^ Genc H, Saracoglu M, Nacir B, Erdem HR, Kacar M (2005). "Long-term ultrasonographic follow-up of plantar fasciitis patients treated with steroid injection". Joint Bone Spine 72 (1): 61-5. PMID 15681250. 
7. ^ Tsai WC, Hsu CC, Chen CP, Chen MJ, Yu TY, Chen YJ (2006). "Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance". J Clin Ultrasound 34 (1): 12-6. PMID 16353228. 
8. ^ Janet Cromley. "A foot hold that spurs healing", Los Angeles Times, November 13, 2006. 
9. ^ Crawford F (2004). "Plantar heel pain and fasciitis". Clin Evid (11): 1589–602. PMID 15652071. 
10. ^ Norris, DM, Eickmeier, KM and Werber B (2005). "Effectiveness of Extracorporeal Shockwave Treatment in 353 Patients with Chronic Plantar Fasciitis". Journal of the American Podiatric Medical Association 95 (6): 517–524. PMID 16291842. 
11. ^ Marc Mitnick. (ESWT) Extracorporeal Shock Wave Therapy for heel pain. Foot Pain Explained. Retrieved on 2006-10-09.
12. ^ Steinmetz M (December 1999). Treatment Choices for Plantar Fasciitis. Letters to the Editor. American Family Physician. - with reply by Barrett SL
13. ^ Perez-Millan R, Foster L (2001). "Low-Frequency Electroacupuncture In The Management Of Refractory Plantar Fasciitis: A Case Series". Medical Acupuncture 13 (1).  - Poster presentation

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Diseases of the musculoskeletal system and connective tissue (, )
ArthropathiesArthritis (Reactive arthritis, Rheumatoid arthritis, Psoriatic arthritis, Felty's syndrome, Juvenile idiopathic arthritis, Still's disease) - crystal (Gout, Chondrocalcinosis) - Osteoarthritis (Heberden's node, Bouchard's nodes) - acquired deformities of fingers and toes (Boutonniere deformity, Bunion, Hallux rigidus, Hallux varus, Hammer toe) - other acquired deformities of limbs (Valgus deformity, Varus deformity, Wrist drop, Foot drop, Flat feet, Club foot, Unequal leg length, Winged scapula) - Chondromalacia patellae
Systemic connective
tissue disorders		Polyarteritis nodosa - Churg-Strauss syndrome - Kawasaki disease - Hypersensitivity vasculitis - Goodpasture's syndrome - Wegener's granulomatosis - Arteritis (Takayasu's arteritis, Temporal arteritis) - Microscopic polyangiitis - Systemic lupus erythematosus (Drug-induced) - Dermatomyositis (Juvenile dermatomyositis) - Polymyositis - Scleroderma - Sjgren's syndrome - Behet's disease - Polymyalgia rheumatica - Eosinophilic fasciitis - Hypermobility
DorsopathiesKyphosis - Lordosis - Scoliosis - Scheuermann's disease - Spondylolysis - Spondylolisthesis - Spondylopathies (Ankylosing spondylitis, Spondylosis, Spinal stenosis) - Schmorl's nodes - Degenerative disc disease - Coccydynia - Back pain (Radiculopathy, Sciatica, Lumbago, Low back pain)
Soft tissue disordersMyositis - Myositis ossificans (Fibrodysplasia ossificans progressiva) - Synovitis - Tenosynovitis (Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome) - Bursitis (Olecranon, Prepatellar, Trochanteric) - fibroblastic (Dupuytren's contracture, Plantar fasciitis, Nodular fasciitis, Necrotizing fasciitis, Fasciitis, Fibromatosis) - enthesopathies (Iliotibial band syndrome, Achilles tendinitis, Golfer's elbow, Tennis elbow, Metatarsalgia, Bone spur, Tendinitis) - Myalgia
OsteopathiesOsteoporosis - Pseudarthrosis - Stress fracture - Monostotic fibrous dysplasia - Skeletal fluorosis - Aneurysmal bone cyst - Osteomyelitis - Avascular necrosis - Paget's disease of bone - Algoneurodystrophy - Osteolysis
ChondropathiesJuvenile osteochondrosis (Legg-Calv-Perthes syndrome, Osgood-Schlatter disease, Khler disease, Sever's disease) - Tietze's syndrome
See also conditions (Q65-Q79, )
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The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD
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List of ICD-10 codes. The version for 2007 is available online at [1]

Chapter Blocks Title
I Certain infectious and parasitic diseases
II Neoplasms
III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
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For other uses of "ICD", see ICD (disambiguation).


The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD
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The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. These codes are in the public domain.

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The Diseases Database is a free website that provides information about the relationships between medical conditions, symptoms, and medications.

It directly integrates the Unified Medical Language System.

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  • Diseases Database

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MedlinePlus is a website containing health information from the world's largest medical library, the United States National Library of Medicine. The site is intended to be used by health care providers and patients, and designed to provide up-to-date, authoritative information.
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eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely, two medical doctors. It was sold to WebMD in January 2006.
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Inflammation (Latin, inflammatio, to set on fire) is the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants.
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The plantar fascia (or plantar aponeurosis) is the thick connective tissue which supports the arch of the foot. It runs from the tuberosity of the calcaneus forward to the heads of the metatarsal bones. It is the source of the painful condition plantar fasciitis.
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The foot is a biological structure found in many animals that is used for locomotion. In many animals with feet, the foot is a separate organ at the terminal part of the leg made up of one or more segments or bones, generally including claws or nails.
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Pronation is an anatomical term to describe a rotation movement[1]. Such movement can occur in the forearm (at the radioulnar joint) and the foot (at the subtalar and talocalcaneonavicular joints)<ref name="Kendall et al." />[2].
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The heel is the prominence at the posterior end of the foot. It is based on the projection of one bone, the calcaneus, behind the articulation of the bones of the lower leg.
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Obesity
Classification & external resources

Silhouettes representing healthy, overweight, and obese.
ICD-10 E 66.
ICD-9 278

DiseasesDB 9099
MedlinePlus 003101
eMedicine med/1653  

MeSH C23.888.144.699.
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A heel spur is a radiological (X-ray) finding, often seen in sufferers from plantar fasciitis.

It consists of a thin spike of calcification, which lies within the plantar fascia at the point of its attachment to the calcaneum, or heel bone.
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calcaneus forms part of the tarsi and constitutes the heel of the human foot or the point of an animal's hock . It is also known as the heel bone.

Human

It articulates with two other tarsal bones, the talus above and the cuboid toward the midfoot.
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Achilles tendon (or occasionally Achilles’ tendon) also known as the calcaneal tendon or the tendocalcaneous is a tendon of the posterior leg. It serves to attach the gastrocnemius (calf) and soleus muscles to the calcaneus (heel) bone.
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Cold compression therapy combines two of the principles of R.I.C.E. (Rest, Ice, Compression, Elevation) to reduce pain and swelling from a sports or activity injury to soft tissues; most notably in boxing.
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Contrast Bath therapy, also known as "Hot/Cold Immersion therapy",[1] is a form of treatment where a limb or the entire body is immersed in ice water followed by the immediate immersion of the limb or body in warm water.
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Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation.
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Glucosamine (C6H13NO5) is an amino sugar and a prominent precursor in the biochemical synthesis of glycosylated proteins and lipids.
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Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood
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A local anesthetic is a drug that reversibly inhibits the propagation of signals along nerves. When it is used on specific nerve pathways, effects such as analgesia (loss of pain sensation) and paralysis (loss of muscle power) can be achieved.
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Ultrasound is a cyclic sound pressure with a frequency greater than the upper limit of human hearing, this limit being approximately 20 kilohertz (20,000 hertz).

Ability to hear ultrasound


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Achilles tendon (or occasionally Achilles’ tendon) also known as the calcaneal tendon or the tendocalcaneous is a tendon of the posterior leg. It serves to attach the gastrocnemius (calf) and soleus muscles to the calcaneus (heel) bone.
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An orthosis is a device that is applied externally to a part of the body to correct deformity, improve function, or relieve symptoms of a disease by supporting or assisting the musculo-neuro-skeletal system. The word is derived from ortho, meaning straight.
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Therapeutic ultrasound is a technique that uses high-frequency sound waves (ultrasound) to speed healing in injured joint or muscle tissue. The frequency used is typically 1-3 Mhz.
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Extracorporeal Shock Wave Therapy or ESWT is a method of treatment of kidney stones (Extracorporeal Shockwave Lithotripsy), shoulder tendinitis, and other conditions by application of high-intensity ultrasonic acoustic radiation.
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Acupuncture (from Lat. acus, "needle" (noun), and pungere, "prick" (verb)) or in Standard Mandarin, zhēn jiǔ (lit: needle - moxibustion) is a technique of inserting and manipulating needles into "acupuncture points" on the body with the aim of restoring
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Electroacupuncture is a form of acupuncture in which acupuncture needles are attached to a device that generates continuous electric pulses, generating a small electric current that flows between pairs of needles. Another term is Percutaneous Electrical Nerve Stimulation (PENS).
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The musculoskeletal system (also known as the locomotor system) is an organ system that gives animals the ability to physically move using the muscles and skeletal system.
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