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Plantar fasciitis - Coggle Diagram
Plantar fasciitis
Risk factors
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running, prolonged standing or walking
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Differential diagnosis
musculoskeletal causes - Achilles tendonitis - presents with tenderness on posterior superior aspect of the heel and long the Achilles tendon on palpation with pain radiating up calf with extension of the foot or when on tiptoes
flexor hallucis longus tendonopathy - may mimic plantar fasciitis but can be differentiated from it by pain with resisted plantar flexion of the big toe
calcaneal stress fracture - typically presents with diffuse, warm swelling and can be diagnosed by squeezing the cacaneum inducing pain. typically occurs in a person who has walked a long distance carrying a heavy pack, pain initially occurs with activity but rest pain may develop. confirmed by radiography.
fat pad atrophy - causes centralized heel pain and a flattened atrophied surface may be felt on palpation. suspect if there is a history of trauma such as landing on the heel. this is also common i elderly people who are obese and in athletes who train on hard surfaces. walking barefoot or on hard surfaces exacerbates in pain
sub - calcaneal bursitis - most common in elderly people and in athletes who have done a lot of walking, jumping and running. presents with posterior heel pain under the fat pad of the calcaneum. made worse by dorsiflexion of the toes
plantar facia rupture - presents as a sudden onset of pain and bruising. there maybe palpable gap and evidence of the collapse in the medial longitude arch
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fracture of the calcaneum - caused by landing on the heel from a height. the person is not able to weight bear
Haglund deformity - a prominence of the superior aspect of the posterior calcaneus. repeated pressure such as from ill fitting shoes can lead to retrocalcaneal
retrocalcaneal bursitis - presents as pain, redness, swelling and tenderness to palpation between the calcaneus and Achilles tendon
sinus tarsi syndrome - caused by repeated hyper pronation of the foot or lateral ankle sprains. the talocalcaneal sulcus is the anatomical space bounded by the talus. pain worse walking or in uneven surfaces and after exercising
other causes include: trauma, arthritic causes, fibromyalgia, neurological causes, infections causes such as osteomyelitis, warts and verrucae
Diagnosis
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ask about the nature of the heel pain, and the person general health. characteristic symptoms include: initial insidious onset of the heel, intense heel pain during the first step after waking or after a period of inactivity with relief upon initiation of movement
pain that reduces with moderate activity but worsens later during the day or after long periods of standing or walking
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examine the foot at rest and when standing and walking, signs will include: tenderness on palpation of the plantar heel area, limited ankle dorsiflexion range, positive windlass test, tightening of the achilles tendon, an antalgic gait or limping
if clinical features of plantar fasciitis are absent or inconsistent consider alternative diagnosis, if diagnosis is uncertain referral to a podiatrist or orthopaedic surgeon for further investigation may be necessary
Definition
Plantar fasciitis is a condition in which there is persistent pain associated with chronic degenerative and reparative processes affecting the origin of the plantar fascia and surrounding peri - fascial surface.
the plantar fascia is a thick fibrous band of connective tissue originating at the calcaneus and inserting on the tendons of the forefoot and proximal phalanges with the purpose of supporting the arch of the foot acting as a shock absorber for pressure placed on the foot
management
give information, explain that most people recover within a year, inform of patient information sites
give self care advice to relieve foot pain, promote healing of the facia and or prevent future. rest foot, wear shoes with good arch support and cushioned heels, avoid walking barefoot, consider purchasing insoles and heel pads to insert in their shoes. with the aim of correcting foot pronation. advise the magnetic devices should be avoided
give advice on measures to provide symptom relief, simple analgesia, paracetamol, NSAID. advise the person to apply an icepack to the foot for 15-20 mins for symptomatic relief
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if symptoms have significant impact on the person and short term relief of symptoms is required, consider corticosteroid injections. be aware that injections are often very painful, post injection pain may last for serval days.. symptoms commonly return within a month following injection. if corticosteroid injections are considered appropriate preferably refer for and ultrasound guided injection. treatment maybe repeated every 6 weeks if beneficial
refer people with mild symptoms to a podiatrist *or physiotherapy if self care advice has not been affective, consider early referral if symptoms impact their normal function ability. consider referral to orthopaedics if pain persists following treatment, specialised treatment maybe offered including: extracorporeal shockwave therapy, a non invasive treatment .