Plantar fasciitis is an inflammation of the plantar aponeurosis. The plantar fascia's main function is to anchor the plantar skin to the bone, thus protecting the longitudinal arch of the foot. The cause of plantar fasciitis is usually overuse in the physically active patient or in the patient unaccustomed to activity. Other causes include abnormal joint mechanics, tightness of the Achilles tendon, shoes with poor cushioning, abnormal foot position and anatomy, and obesity. In the younger patient, collagen vascular diseases and rheumatic diseases can lead to this entity. Patients present with pain on the plantar surface of the foot that is worse on arising and after physical activity. Examination usually reveals a point of deep tenderness at the anterior medial aspect of the calcaneus, the point of attachment of the plantar fascia. Plantar fasciitis is generally a self-limiting disease. Short-term treatment consists of rest, ice, nonsteroidal anti-inflammatory agents, heel and arch support shoe inserts, and dorsiflexion night splints (molded ankle-foot orthosis that holds the plantar fascia and Achilles tendon stretched.) Patients should be taught Achilles tendon stretching exercises and be told to avoid walking barefoot on hard surfaces. In severe cases, a short-leg walking cast may be applied to unload and rest the plantar fascia. Glucocorticoid and local anesthetic injections may be helpful. Glucocorticoid injections are associated with plantar fascia rupture and potentially serious sequelae. Only those with appropriate experience should perform this procedure. 2 ,25,,26 and 27
Long-term therapy consists of proper foot support, stretching, and strengthening exercises. Surgical intervention may be required in refractory cases. Patients should be referred to a podiatrist, orthopedist, or other appropriate practitioner. 25
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