Connecticut Medicine

Mar 2015

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volume 79, no. 3 159 Plantar Fasciitis Benjamin Gardner, md P lantar Fasciitis is a common cause of heel pain. Generally speaking it is thought of as inflammation of the thick band of tissue, the plantar fascia, which extends from the each of the toes to the calcaneus: "e incidence and prevalence of plantar heel pain are uncertain. However, it has been estimated that 7% of people aged over 65 years report tenderness in the region of the heel, that plantar heel pain accounts for a quarter of all foot injuries relating to running, and that the diagnosis and treatment of plantar heel pain accounts for over 1 million visits a year to physicians in the USa. e condition affects both athletic and sedentary people, and does not seem to be influenced by gender." 1 Diagnosis Pain is usually reported primarily at the anterior plantar calcaneus. e pain is frequently point tender- ness where the fascia inserts into medial calcaneus often bilateral, increased with passive ankle dorsiflexion and walking. One of the more definitive pearls in diagnosing is the report by the patient that it hurts most upon first waking up (or after a prolonged period of rest) and eases somewhat after stretch- ing or walking. Imaging radiologic evaluation of plantar fascial pain by X-ray, mri, ultrasound, or bone scan is usually noncontributory except to rule out other pathology, such as bone spurs or stress fractures (Figures 1 and 2). as is debatable whether bone spurs cause plantar fasciitis, the identification of a bone spur radiographically has questionable value in the diagnosis and management of plantar fasciitis. e presence of a bone spur, therefore, may be only an incidental finding. Treatment e vast majority of cases will resolve with conserva- tive treatment. recalcitrant cases (over six months) are considerably more difficult to solve. Conservative Treatment • Rest: as with any inflammatory condition, the area needs time to settle down and heal. • Changing activity: slowing the rate of increased workouts, standing for shorter periods of time, or biking rather than running can all reduce the pressures on the fascia. • Stretching: Toe exten- sion helps with the fascia itself, as does, standing facing a wall with one's toes "up the wall." Calf stretching helps in the same manner as it would for achilles tendonitis. • Ice: remember this is an inflammatory condition. There are many novel ways of icing, including ice massage with a frozen lacrosse ball or bucket full of ice. • Analgesics: Simple anal- gesics include over the counter antiinflammatories. more complex medications are indicated in the list that follows. Benjamin Gardner, md, director of Health Services, Choate rosemary Hall, Wallingford, assistant Clinical Professor, Yale University medical School, new Haven, and assistant Clinical Professor, Yale School of nursing, new Haven. 2

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