My Orthopaedic Surgeon

A common foot complaint is pain in the bottom of the heel. This is often referred to as heel spurs or plantar fasciitis.

J Nucl Med 2006; 47:1577–1580
Conclusion: Critical evaluation of plantar blood-pool images provides prognostic information on the response to localized injection into the enthesis. Reporting such studies is simple and reproducible.

News item: Nov 1, 2005 Berlin, Germany - A single injection of botulinum A toxin appears to decrease chronic plantar fasciitis pain, with the improvement lasting at least a year [1]. The findings come from a pilot study in nine patients reported in the November 2005 issue of the Annals of the Rheumatic Diseases, and the authors are now planning a larger, placebo-controlled trial.

Plantar fasciitis is the commonest cause of heel pain. We see about 50 new patients per year in a population of 260,000 or 193/million/year. However, this is only the tip of the iceberg as many people probably never consult a practitioner about this condition, or are treated by a GP, podiatrist, rheumatologist or sports medicine practitioner.

Wheeless' Textbook of Orthopaedics
disorder of unknown etiology characterised by local proliferation of abnormal fibrous tissue in the plantar fascia
- this tissue is locally aggressive and progressively replaces the normal plantar aponeurosis
- this leads to often painful thickened fascia with nodules from 0,5-3 cm in diameter
- may also infiltrate the dermis or very rarely the flexor tendon sheath (flexion contracture of 2nd toe)
- age range from childhood until 6th decade, more common in men than in women
- 25 % of patients have bilateral involvement
- in older people sometimes associated to other fibromatoses like Dupuytren's in the hand or La Peyronie's disease, a fibrous infiltration of the corpora cavernosa
- increased incidence in patients with:
- diabetes mellitus
- seizure disorders

Wheeless' Textbook of Orthopaedics
Surgical anatomy, considerations and technique of release for plantar fasciitis

Plantar fasciitis AAOS Patient Information

Plantar Fasciitis SCOI Patient information

Plantar Fasciitis is a condition that is sometimes called a heel spur. This condition causes pain on the bottom of the heel when putting weight on the foot. There are probably many underlying causes of heel pain, and some physicians feel that it is probably more accurate to simply make a diagnosis of heel pain rather than try and define an absolute cause in every instance of heel pain.

A common foot complaint is pain in the bottom of the heel. This is often referred to as heel spurs or plantar fasciitis. It commonly is painful the first few steps in the morning or after rest.

The most common cause of heel pain is plantar fasciitis. It is usually caused by a biomechanical imbalance resulting in tension along the plantar fascia. The diagnosis is typically based on the history and the finding of localized tenderness. Treatment consists of medial arch support, anti-inflammatory medications, ice massage and stretching. Corticosteroid injections and casting may also be tried. Surgical fasciotomy should be reserved for use in patients in whom conservative measures have failed despite correction of biomechanical abnormalities. Heel pain may also have a neurologic, traumatic or systemic origin.
AFP April 15, 1999 Full Text STEPHEN L. BARRETT, D.P.M.,ROBERT O'MALLEY, D.P.M.

Author: Shepard R Hurwitz, MD
Synonyms and related keywords: heel pain, plantar heel pain, inflamed fascia, foot deformity
Background: Plantar heel pain is a common problem in adults. The most common cause of heel pain is inflammation to the dense tissue extending from the calcaneus to the metatarsal region, thus the descriptive term plantar fasciitis. Though not all cases of plantar heel pain are due to plantar fasciitis, an inflamed or damaged fascia may contribute to painful conditions caused by nerve injury or soft-tissue inflammation in local muscle and the fat pad. With the Internet and an increasing public awareness of plantar fasciitis comes greater demand for treatment when time and home remedies do not alleviate pain. The nature of upright human activity is repetitive tensile and compressive stress of the fascia that has a cumulative ability to damage or transform the tissue. Longer lifespans and greater recreational expectations of working adults also are contributing to the volume of patients seeking attention for plantar fasciitis.

Plantar fasciitis is a common foot disorder encountered in the outpatient clinic.1, 2, 3, 4, 5 The typical presentation is sharp pain localized along the middle to posterior aspect of the sole of the foot. Plantar fasciitis is often, but not always, associated with a heel spur (exostosis). Most patients with this condition have satisfactory outcomes with nonsurgical treatment.
Synonyms and related keywords: heel pain syndrome, plantar heel pain, proximal plantar fasciitis, subcalcaneal pain, orthotic arch support, shoe insert, heel pad, fat pad, heel spur, exostosis
Foye & Stitik 2008

Definition - Pain at attachment of thickened central part of plantar aponeurosis & intrinsic muscles to Medial Calcaneal Tuberosity
Anatomy, epidemiology, aetiology, pathogenesis, clinical features, investigation, differential diagnosis, natural history, management

one of several causes of heel pain;
- the pain is located somewhat more distally than in other causes of heel pain syndrome
- symptoms include gradual onset of pain at the origin of the plantar aponeurosis and 1 cm distal to this area
- no definitive evidence that plantar fasciitis is linked with abnormal foot posture (pes planus or pes cavus)