Plantar Fasciitis
Overuse-related degenerative and inflammatory change at the plantar fascia origin on the medial calcaneal tubercle, producing heel pain.
Overview
Plantar fasciitis - more accurately plantar fasciopathy - is a chronic degenerative process at the origin of the plantar fascia on the medial tubercle of the calcaneus. Repetitive traction loading, combined with reduced ankle dorsiflexion and high loading rate during gait, is thought to initiate microtears and failed repair.
Epidemiology
It is the most common cause of plantar heel pain, affecting an estimated 10 percent of the population over a lifetime. Peak incidence is between 40 and 60 years. Runners, obese individuals, and those with occupations requiring prolonged standing are at higher risk.
Symptoms
Patients describe sharp medial heel pain worst with the first steps in the morning or after rest, easing with ambulation and worsening again by the end of the day. Tenderness is localised to the medial calcaneal tubercle. Symptoms may persist for months to years.
Imaging
Diagnosis is clinical. Ultrasound demonstrates plantar fascia thickening (>4 mm) and hypoechogenicity. MRI shows similar features and is useful when the diagnosis is uncertain or for refractory cases. Plain radiographs may show incidental heel spurs, which are of limited prognostic significance.