MANUAL MINORS
Plantar fasciitis is one of the most common causes of heel pain. It occurs due to inflammation of the plantar fascia, a thick tissue that connects the heel bone to the toes and helps support the foot arch.
The condition generally arises from overuse or excessive strain on the fascia and is characterised by sharp pain at the base of the heel, particularly when taking the first steps after rest or at the start of physical activity.
Diagnosis
Diagnosis is based on the clinical presentation of pain in the lower heel, especially in the morning or after prolonged periods of inactivity. Physical examination reveals tenderness at the site where the plantar fascia attaches to the heel (calcaneus). Imaging tests such as ultrasound or magnetic resonance imaging (MRI) can confirm inflammation and rule out other causes of heel pain, although they are rarely needed for clinical diagnosis.
Differential Diagnosis
Condition | Key Difference |
|---|---|
Calcaneal spur | Can coexist with plantar fasciitis, visible on heel X-rays. |
Morton’s neuroma | Neuropathic pain in the sole, typically between the toes, not in the heel. |
Achilles tendinopathy | Pain in the back of the heel, not in the sole. |
Calcaneal stress fracture | More constant pain, not related to first steps or rest. |
Emergency Management
Initial emergency management involves measures to reduce inflammation and pain, such as rest, ice application to the affected area, and the use of analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs).
It is essential to advise patients to avoid activities that aggravate the pain, such as prolonged standing or running. Heel pads or orthotic insoles may provide immediate relief by reducing tension on the plantar fascia.
Definitive Treatment
Conservative treatment is the cornerstone, including physiotherapy focused on stretching the Achilles tendon and plantar fascia. It is also recommended to switch to supportive footwear. In chronic cases, corticosteroid injections can help reduce inflammation. If conservative measures fail to provide relief after several months, surgery (plantar fasciotomy) may be considered, although this is rare. Most patients experience significant improvement with non-surgical treatment.
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