Plantar fasciitis refers to the inflammation and thickening of the plantar fascia, located on the medial anterior part of the foot, which originates from the medial calcaneal tuberosity. This fibrous aponeurosis undergoes micro-tears and strained attachments due to repetitive traction stress. The condition is often observed in obese individuals and presents with bilateral symptoms. The typical pain pattern involves initial intensity in the morning, decreasing throughout the day, and re-emerging by the end of the day. Diagnostic clues include pain during toe walking, passive dorsiflexion of the toes, or pressure on the plantar fascia. It is important to note that the presence of a heel spur does not directly cause the pain but rather indicates an associated pathology.
While approximately 50% of individuals with heel pain may have a heel spur, it can also be found in about 16% of the population without heel pain. Moreover, studies have shown that spur formation originates from the insertion point of the flexor digitorum brevis muscle, unrelated to the plantar fascia. Consequently, not all heel spurs should be considered as the primary cause of pain, and additional diagnostic methods such as bone scanning, which reveals increased technetium uptake in inflamed periosteal tissue, can aid in differential diagnosis. Another potential source of pain in the region is compression of the lateral plantar nerve branch beneath the medial calcaneal spur, which may require surgical release. This particular condition is characterized by more intense and occasionally electric shock-like pain episodes. Diagnostic tools such as foot radiographs, bone scans, and electromyography (EMG) can assist in diagnosing plantar fasciitis and heel spurs. Non-surgical treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), orthotic devices, and steroid injections.
Special shock-absorbing heel inserts (UCBL cup) and plastazote insoles can be utilized to alleviate symptoms. In cases of plantar fasciitis, relief can be achieved by elevating the posteromedial aspect of the heel and reducing pressure on the medial arch using polypropylene foot molds. Surgical excision of the heel spur is rarely required, typically in only 2-25% of patients. Encouraging patients about the natural course of the disease has been found to facilitate a prompt and favorable response to treatment.
