- Plantar fasciitis: description
- Plantar fasciitis: symptoms
- Plantar fasciitis: causes and risk factors
- Plantar fasciitis: examinations and diagnosis
- Plantar fasciitis: treatment
- Plantar fasciitis: disease course and prognosis
The plantar fasciitis (also: plantar fasciitis) is an inflammation of the tendon plate of the sole of the foot and is typically triggered by overuse. Affected is usually the approach of the tendon plate on the heel bone. The plantar fasciitis is characterized by heel pain, which occurs especially under pressure and stress. Read all about the causes and treatments of plantar fasciitis.
ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. M72
Causes and risk factors
Examinations and diagnosis
Disease course and prognosis
Plantar fasciitis: description
Plantar fasciitis is the most common cause of chronic heel pain (calcaneodynia). It can significantly burden the patient. The plantar fascia, that tendon plate under the foot that is inflamed in the case of plantar fasciitis, arises at the lower and anterior edge of the heel bone, the so-called heel bone (tuber calcanei). It connects the tarsal with the metatarsal bones and toe joints. Everything together forms the Fußlängsgewölbe...
As the foot rolls off, the plantar fascia is strained by the so-called windlass effect, which ensures the transmission of power from the forefoot to the hindfoot. The fascia has the task of tensioning the longitudinal arch, aligning the forefoot and forefoot, absorbing shocks and passively lifting the arch of the foot.
The term plantar fasciitis is based on the Anglo-American term "plantar fasciitis". Pathologically-anatomically, however, the symptoms correspond to the "heel pain syndrome", while the "plantar fasciitis" means a clinical picture, which takes place over the second sphenoid and metatarsal bones.
Mostly the term "heel spur" is wrongly used. A heel spur is a bony spur on the heel bone (calcaneus) in the insertion area of the tendon plate of the sole of the foot (plantar fascia). It is often incidental to a lateral x-ray of the foot. Although it is associated with plantar fasciitis, but not their cause and mostly symptom-free. The heel spur does not cause the heel pain, but the plantar fasciitis.
Plantar fasciitis: symptoms
The onset of plantar fasciitis is insidious. Over time, symptoms gradually worsen, usually over weeks or months. The symptoms occur initially only during exercise, later in the morning when getting up and at rest. You can lead to the inability to walk. A sign of plantar fasciitis is a heel pain immediately after getting up, but disappears after a short walk. During exercise, those affected initially experience painful episodes at the beginning of the exercise that diminish as they warm up. At the end of the training the symptoms return. In particular, sprinting and jumping intensify the pain.
Plantar fasciitis: causes and risk factors
Plantar fasciitis is caused mainly by overloading the plantar fascia. This can occur during sports, especially when running or jumping. Plantar fasciitis is particularly prevalent in the fourth and fifth decades of life, probably related to age-related wear. About ten percent of all athletes in the running disciplines are affected by plantar fasciitis. Other risk sports include basketball, tennis, football and dancing. However, there is no connection between the duration of training and the frequency of the complaints.
Inflammation of the fascia at the insertion (insertion endinopathy) due to excessive stress, discomfort may occur. Excessive stress can be caused for example by a shortened Achilles tendon. Bursitis in the area of the plantar fascia approach may also cause pain in this area.
Furthermore, injuries can cause plantar fasciitis. Even the smallest changes can cause collagen fiber damage, leading to chronic inflammation. For example, patients claim to have caught the heel crossing the road at the edge of the road.
Plantar fasciitis: examinations and diagnosis
If plantar fasciitis is suspected, you can consult a family doctor or orthopedic specialist. Plantar fasciitis has a characteristic medical history (history), which makes the diagnosis fast. Typical questions of the doctor during anamnesis interview could be:
- Did you hurt your foot?
- Does it hurt under the heel under load?
- When will the pain occur? With which movements?
- When is the pain strongest? When do you let up?
- Where does the pain go from?
During the examination, the patient usually indicates a localized pressure pain under the heel at the base of the fascia. A rupture would show bruising on the sole of the foot with pressure pain.
If the symptoms are acute, it is likely to be a sprain or, rarely, a rupture of the plantar tendon. The person concerned states that he has to stop the exercise immediately and that running was no longer possible because of pain, or that the symptoms worsened. Sometimes a swelling or a hematoma can also give an indication of other injuries such as fractures, muscle injuries or a tear.
Plantar fasciitis: Imaging diagnostics
For the imaging diagnosis of plantar fasciitis, ultrasound and magnetic resonance tomography are used in addition to X-rays.
Plantar fasciitis diagnosis: X-ray
In lateral X-rays, about 50 percent of patients with plantar fasciitis show heel spurs. However, this is not a diagnostic criterion and is seen in about 25 percent of the population on the radiograph. To rule out a hindfoot deformity, x-rays of the foot are made in three planes.
Plantar fasciitis diagnosis: ultrasound
In ultrasound, a thickened plantar fascia can be seen in a longitudinal section of plantar fasciitis. The plantar fascia has a thickness of three to four millimeters in a healthy, while in a plantar fasciitis, the fascia layers are often thickened to seven to ten millimeters.
Plantar fasciitis diagnosis: magnetic resonance imaging
Magnetic Resonance Imaging (MRI) can be used to make accurate sectional images of the foot. In order for the doctor to be able to judge better, a contrast agent is usually used, which is injected via the vein. With MRI, the exact location and extent of the inflammation can be identified. Especially before surgery, the use of MRI makes sense, also to avoid possible fractures, partial fractures, tendon abnormalities and bone contusions.
Plantar fasciitis: treatment
Plantar fasciitis is one of the most persistent and frustrating sports injuries. Although there are many conservative and surgical treatment options, plantar fasciitis can easily become chronic.
Plantar fasciitis treatment - conservative
In order to reduce the inflammation and the pain of a plantar fasciitis, the treatment initially consists of relief or adjustment of the athletic movement sequences. The training methods and circumstances, such as mountain running, running surfaces of sand or boulders, sudden training increase, must be analyzed and changed if necessary.
Stretching: Stretching exercises are an essential part of the conservative treatment of plantar fasciitis in the calf and plantar muscles. In one study, 72 percent of the patients had symptoms relieved by stretching alone. For example, a stretching exercise involves rolling the foot over a bottle filled with ice. The passive flexion of the foot with a towel, which is wrapped around the forefoot and pulled towards the head, is also a good stretching exercise. It is best to repeat the stretching exercises about three times a day for at least ten minutes.
shoe inserts: Shoe pads that support and erect the mid-body longitudinal arch and relieve the fascia have a positive effect. Night support rails in the extended position of the upper ankle help especially in case of severe pain in the morning.
physical therapy: Special massages such as transverse friction massages on the tendon are initially uncomfortable, but help with pain relief.
drugs: Medicamentous non-steroidal anti-inflammatory drugs can be used. Cortisone injection therapy is another option, with up to 70 percent of the pain disappearing. However, repeated injections can reduce the metabolism of the tendon tissue so much that the risk of a tear increases sharply.
Extracorporeal shockwave therapy (ESWT)In the extracorporeal shock wave therapy, ultrasound shock waves are brought into the injured region via the skin. The method has become increasingly important because of its good success in physical therapy to improve movement and reduce pain. However, as treatment costs are very high, only chronic and non-conservative cases are treated.
X-ray irradiation inflammation: The so-called X-ray radiation is also used in conservatively treated plantar fasciitis and causes pain in about two-thirds of patients treated with it. Disadvantage, however, is the radiation exposure.
Operative plantar fasciitis treatment
In rare cases, after six months, if none of the conservative measures help and the symptoms remain unchanged, surgery may be considered. However, this should be reserved for cases that do not respond to conservative treatment attempts - about five percent of all patients with plantar fasciitis must be operated on.
Open notching is the standard procedure for surgical treatment of plantar fasciitis.The plantar fascia is scored at the origin over a short, oblique skin incision above the maximum pressure-painful point on the sole of the foot. Thus, painful scarring can be avoided. If a heel spur is present, it can be removed at its base. Endoscopic treatment is also possible. The healing period is thus usually shorter.
After surgery, a calf foot splint should be worn for about two days. Thereafter, it is important to use a cautious partial load in the first few days, using special insoles. Also required is physiotherapy with a targeted foot muscle strengthening and stretching program.
After the sixth postoperative week, the running load can be slowly increased, whereby initially only mild endurance training is recommended. Jump loads should still be strictly avoided before the tenth to twelfth postoperative week. The total healing takes at least twelve weeks after surgery, in some cases even up to a year.
Complications of the operation
As a complication, pain may persist after surgery or on the midfoot. This happens when the complete plantar fascia has been severed, as the tension of the longitudinal arch has changed. As with any surgery, general surgical risks such as superficial or deep infections, painful scars or deep vein thrombosis can not be ruled out.
Plantar fasciitis: disease course and prognosis
The majority of patients with plantar fasciitis are successfully cured with conservative treatments. The course of the disease plantar fasciitis but can be tedious and take one to two years. An athlete must severely reduce his load during this time. After surgical treatment, about nine out of ten patients, including athletes, report an improvement in their symptoms by 80 percent.