 Plantar fasciitis is a painful inflammatory process of the plantar fascia

 Most common cause of foot pain in outpatient medicine  Majority of cases occur in patients with no other disease

 Feet roll inward too much when you walk (excessive pronation)  High arches or flat feet  Walk, stand, or run for long periods of time, especially on hard surfaces  Overweight  Wear shoes that don't fit well or are worn out  Tight Achilles tendons or calf muscles

 Extrinsic factors  Training errors  Improper footwear  Unyielding running surfaces  Intrinsic factors  Pes planus w/ hyperpronation  Pes cavus w/ supination  Tight heel cords  Weak intrinsic foot muscles

 Classic presentation: heel pain in the morning when first rising from bed  May improve through the day but tends to hurt again by afternoon and evening  Reoccurs upon standing after prolonged sitting  Worse with walking barefoot and walking up stairs

 X-ray  MRI

 Calcaneal stress fracture  Flexor hallucis longus tendonitis  Tarsal tunnel syndrome  Fat pad insufficiency  Paget’s disease of bone  Mid foot DJD  Reiter’s syndrome (inflammatory arthritis)

 Planta fascia test vs foot intrinsics  Plantar fascitis  Passively DF toes & ankle & palpate medial plantar tubercle of the calcaneus  Foot intrinsics  Curl toes around finger & then resist (+ = pain for both tests)

 Nonsteroidal anti-inflammatory drugs (NSAIDs).  Ibuprofen (advil, motrin)  Naproxen (aleve)  Corticosteroids  Iontophoresis  Injection

 Surgery  Few people need surgery to detach the plantar fascia from the heel bone  Side effects include a weakening of the arch in your foot

 Modalities  Iontophoresis  Ultrasound  Shoe inserts  Taping  Supportive shoes  Night splints (orthitic)  Stretching program: arch, calf  Soft tissue massage  Ice

 A calcaneal spur is a small bony projection that is formed on the calcaneus or heel bone, either at the back of the heel or under the sole of the heel

 A sharp, stabbing or dull but intense pain under or on the inside of the heel  The pain is typically relieved during rest, but is worse after getting up again  As a rule of thumb, it is most painful first thing in the morning  The feet or calf muscles may feel very stiff in the morning, making walking difficult

 The pain is made worse by walking on a hard surface or carrying something heavy  The pain can become so severe that it becomes difficult to continue your daily work  Calcaneal spurs may cause no symptoms at all

 It's caused by damage to the bone accumulating over a long period of time as a result of chronic inflammation of the Achilles tendon in the calf or the tough sinewy tissues called the plantar fascia, which is found on the soles of the feet

 People who are overweight and middle-aged  Weekend athletes whose muscles aren't tuned up for sudden intense activity  People who have feet that are pronated and not corrected

 X-ray

 Heel Tap ("Bump") Test  Patient sitting or lying supine  The involved foot off the end of the table & the knee straight  Examiner stabilizes the lower leg with one hand & bumps the calcaneus with the other hand  Examiner bumps the calcaneus 2–3 times with progressively more force  Positive test pain (at area of complaint)

 Avoidance of wearing high heels is recommend in all cases  Pain killers  Cortisone injection  Surgery

 Stretching exercises  Shoe recommendations  Shoe inserts or orthotic devices  Taping or strapping to rest stressed muscles and tendons

 It is the inflammation of the Achilles tendon  The weakest area of the Achilles tendon in adults is found approximately 3 cm above the point of attachment on the heel bone  In children and adolescents the weakest area is often at the actual point of attachment on the heel bone  Inflammation of the Achilles tendon is therefore relatively rarely seen in children and adolescents

 Pain when activating the Achilles tendon (running and jumping), when applying pressure and with stretching of the tendon  The tendon often feels thickened

 Age  Overuse of the tendon  Sudden extra exertion, such as a final sprint  Calf pain  Starting up too quickly, especially after a long period of rest

 X-ray  MRI

 Anterior Drawer Test  Steps Athlete is sitting over the edge of the table with the knee bent  Examiner stabilizes the lower leg with one hand & cups the calcaneus with the forearm supporting the foot in slight plantar flexion (~ 20° ) and slight inversion (few degrees)  Examiner draws the calcaneus & talus anteriorly and slighlty medially  Positive test pain, anterior translation, dimple/sulcus, and/or "clunk"

 Rest, to allow the inflammation to settle  Regular pain relief with non-steroidal anti- inflammatory drugs (NSAIDs), such as ibuprofen  Steroid injections  Surgery (rarely needed) to remove fibrous tissue and repair tears

 Stretching  Strengthen the weak muscle group in the front of the leg and the upward foot flexors  Footwear to be in good condition (good running shoes with shock absorbing heel and close fitting heel cap if an athlete)  Pressure on the Achilles tendon can be relieved by using shoes with an elevated heel

 If experiencing tenderness in the Achilles tendon during the rehabilitation period, treatment with ice for a period of at least 20 minutes is recommended  Bandaging  Ultrasound