PLANTER FASCIITIS

Planter fasciitis is a musculoskeletal disorder affecting the

fascial enthesis (planter fascia). It is the inflammation of
the planter fascia caused due the excessive stretching of
the planter fascia. In pes caplanus and lowered
longitudinal arch foot, excessive tensile strain within
fascia produces microscopic tears and chronic
inflammation. Stress shielding and metabolic
disturbance, formation of free radicals, hyperthermia
and genetic factor are other related factor of planter
fasciitis. If left untreated then there is development of
boney out growth from the calcaneus known as heel
spur. It is not the part of the inflammation but body’s
natural mechanism of preventing the fascia from
detaching.
Planter fascia is a broad band of tissue run along the planter
surface of the foot. It is attached to calcaneus and support
arch by acting bow string. When stretched excessively cause
fascia to tear and result in inflammation and pain known as
planter fasciitis.

BIOMECHANICAL AETIOLOGY
Planter fasciitis is caused due to excessive sub tallar joint
pronation, also in addition to this the tightening of claf
muscle cause restriction of dorsiflexion at ankle joint .
when these factor are added to excess result in foot
dorsiflexion at mid tarsal joint which places extra stress
on planter fascia.

RISK FACTORS
Obesity.
Pes planus.
Pes cavus.
Repeated shock to the fascia.
Running on the hard ground.
Active after a period of relative inactivity.

SYMPTOM
 Sharp pain at morning in heel.
 Stiffness and aching.
 Planter fascia inflexible during initial walking.
 Tenderness in the medial part of the heel.
 Pain in walking.

INVESTIGATION AND EXAMINATION

Blood test: - Are not helpful.
X-ray: - Helps to indicate hell spur.
Ultrasound: - Shows swelling and thickening of aponurosis
in fascia.
Bone scan or M.R.I: - done to investigate the site of
inflammation.

DIFFERIANTIAL DIAGNOSIS
MOST COMMONLY
 Achillies tendonitis: - inflammation of the achillies
tendon.
 Tarsal tunnel syndrome: - Posterior tibial nerve
passes under flexor retinaculum which runs between
the medial malleolus and calcaneum. Depression of
the tibial nerve at this site produces pain, numbness,
burning on medial side of foot ankle or calf known as
tarsal tunnel syndrome.
 Mortons nuroma: - Pain in the metatarsal region
due to fallan transerve arch with pressure on lateral
planter nerve.
 Sever’s disease : - Aphophysitis of calcaneus in
adolescents and children who are actively engaged in
sport, they are treated with icing, Achilles tendon
stretching, NSAID’s.
  Stress fracture of metatarsal.

RARELY
 Fibro sarcoma.
 Metastasis.

 Foreign body.
 Paget’s disease of bone.
 Osteomyelitis
 Tuberculosis
 Gout

MANAGEMENT AND TREATMENT

CONSERVATIVE
Losing weight.
Rest of foot.
Correction of arch of foot by orthotics.
Splinting and casting.
Using night splint.
Fiber glass walking cast.

MEDICAL
Use of NSAID’s : -Use of these drugs help to reduce pain
and inflammation. Drugs used are ibuprofen,
paracetamol etc.
Corticosteroid injections are used for short term pain
relief.

OTHER MODALITIES
Extracorporel shock wave therapy.
Botulibnum toxin A injection
Radiotherapy.
SURGERY
It is done to release heel spur and is done in the last
sytage of the condition.

PHYSIOTHERAPY
Calf muscle, planter fascia and Achilles tendon
stretching exercise are done.
Deep massage of sole of foot stretches planter
fascia.
Ultrasound, LASER treatment or iontoporosis wiith
dexamethasone for pain relief and reduce
inflammation.
 TO
PIC PLA
ON NT
SUBMITTED BY : -
:- ER
MOHAN JOSHI
FAS
RD
CIIT B.P.T 3 YR
IS
SUBMITTED TO: -
DR.BIBEK CHAUHAN(mpt ortho)