plantar fasciitis

Plantar fasciitis: description

Plantar fasciitis is the most common cause of chronic heel pain (calcaneodynia). It can significantly burden the patient. The plantar fascia, the 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 bump (tuber calcanei). It connects the tarsal with the metatarsal bones and toe joints. Everything together forms the Fußlängsgewölbe ..

When the foot rolls off, the plantar fascia is put under tension 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, it is not its cause and is usually symptom-free. The heel spur does not trigger 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 in peace. They can lead to 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, which diminish as they warm up. Towards 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 essentially caused by overburdening of 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 can 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. The plantar fasciitis has a characteristic 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 go?
• Where does the pain radiate?

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 stress immediately and that running was no longer possible because of pain, or that the symptoms worsened. Sometimes a swelling or a hematoma can also be an indication of other injuries such as fractures, muscle injuries or a tear.

Plantar fasciitis: Imaging diagnostics

For imaging diagnosis of plantar fasciitis, ultrasound and magnetic resonance imaging 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 fascial 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 cross-sectional images of the foot. In order to better assess the doctor, 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 adaptation 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 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 for improving movement and reducing 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 notch

Open notching is the standard procedure of surgical treatment of plantar fasciitis. The plantar fascia is scored at the origin via 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 time is thus usually shorter.

After surgery, a lower leg 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 an operation, 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.