Repetitive microtrauma from prolonged use of the foot causes tensile overload and damage to the plantar fascia. This can lead to the inflammation of the fibrous tissue that makes up the plantar aponeurosis.
The plantar fascia (aponeurosis) is a thick connective tissue that supports the plantar side of the foot. The plantar aponeurosis originates on the calcaneal tuberosity and inserts on the heads of the metatarsal bones. Severe heel pain and tenderness, particularly pronounced with first steps in the morning or with dorsiflexion, is the hallmark feature of plantar fasciitis.
Heel pain typically is worse in the morning, likely due to reduced blood flow throughout the night. The pain is also worsened by dorsiflexion due to the increased stress on the plantar fascia.
Treatment usually begins with lifestyle changes. Patients should decrease physical activities that may be causative or aggravating (e.g., strenuous exercise, barefoot walking). Stretching exercises are often recommended.
A short-term trial of nonsteroidal anti-inflammatory drugs (NSAIDs) is sometimes effective in patients with plantar fasciitis. NSAIDs block the synthesis of prostaglandins leading to decreased inflammation and pain.
In some patients who experience significant pain and disability despite the lifestyle modifications and NSAIDs, a single glucocorticoid injection can be attempted to decrease inflammation and relieve pain.
Most patients with plantar fasciitis will improve with conservative therapy. Surgery is the last-resort treatment for patients who do not respond to at least 6-12 months of nonoperative therapy.
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