Plantar Fasciitis is a common cause of heel pain in adults. It occurs in 10% of running athletes. The plantar fascia is a long, connective tissue that lies directly beneath the skin on the bottom of the foot.
This tissue supports the arch of the foot and is inserted from the heel bone to the heads of the metatarsal bones. The plantar fascia inserts into the medial tuberosity of the calcaneous. The achilles tendon inserts into the posterior aspect of the calcaneous. The plantar fascia is formed by three bands with the plantar aponeurosis being the central part of the plantar fascia. Foot pain due to inflammation of the plantar aponeurosis is usually caused by repetitive strains.
As a person walks, the plantar fascia ligament stretches when the foot hits the ground. This ligament is a dynamic stabilizer of the arch of the foot. If the plantar fascia ligament is forced to stretch excessively in an abnormal fashion, damage to the fascial tissue may occur. Pain symptoms will intensify with prolonged exercise or standing, especially with the first steps. Stretching exercises or walking often helps in relieving the pain.
Treatment
Published data shows 80-90% resolution of symptoms within 12 months regardless of treatment. Typical treatment for Plantar Fasciitis consists of: rest and ice, anti-inflammatory medication, shoe inserts, heel cord stretching exercises, and injections. Surgery is the last resort and should only be performed after the symptoms persist for over 6 months. Surgical methods can be open or endoscopic.
When performing an injection, the physician will not inject into the fascia itself—this may cause it to rupture, and the physician cannot inject into the fat pad, as this may cause fat pad atrophy. With a blind injection, the site is identified and marked on the medial side of the foot and betadine is used. The needle is inserted in a medial to lateral direction, one finger breath above the sole of the foot in a line that corresponds to the posterior aspect of the tibia. The solution is injected past the midline of the width of the foot.
When an injection is done with ultrasound guidance, the injection can be done on the long or short axis of the fascia. In the long axis technique, the fascia can be injected proximally or distally. In the short axis of the fascia, the injection is done by the medial approach, injecting deep or superficial to the fascia and the physician will use needling with platelet injection.
