Platar Fasciitis (heel-spur syndrome)

Plantar FasciitisA Textbook ReadingLia Angelin Adriana

Prof. dr. Widiastuti Samekto, PAK, SpS(K), MSc.AnatomyHuman foot is a complex unitIt consists of 26 bones:14 phalanges 5 metatarsals 7 tarsalsCan be divided into 3 functional segments: HindfootMidfootForefoot

The bones are stabilized by the ligaments

There are extrinsic muscles and intrinsic musclesThose that the origin is away from the foot called extrinsic foot musclesWhereas those that originate and insert within the foot called intrinsic foot musclesFoot Muscles

Plantar FasciaPlantar fascia is a continuation of the plantaris tendon

Its origin is upon the medial tubercle of the calcaneus then splits into five bands to attach to each digit

Plantar fasciaPlantar fascia is a thick fibrous band of tissue that runs along the bottom of the foot.

This tissue connects the heel to the base of the toes and stretched with every step

Plantar fascia acts as a shock-absorbing bowstring within the arc of the foot.

Plantar FasciitisPlantar fasciitis is inflammation of the thick fibrous band of tissue (plantar fascia) that runs along the bottom of the foot.

About 2 million people in US seek for medical treatment because of plantar fasciitis annually

Symptoms and SignsPlantar fasciitis is presented by a sharp stabbing pain at the bottom or front of the heel bone.

The pain of plantar fasciitis is usually located close to where the fascia attaches to the calcaneous, also known as the heel bone.Pain is often most intense with yourfirst steps when getting out of bed in the morning.

Heel pain is more severe following periods of inactivity (resting or sleeping) when getting up and then subsides, turning into a dull ache.

Abnormalities of plantar anatomy: flat foot, high archesOverload physical activities or exercises

Wearing incorrect shoes

Overweight

PlantarFasciitisTear and Inflammation of the Plantar FasciaRISK FACTORSpur

Age

Abnormalities of plantar anatomyPlantar fasciitis is also influenced by the mechanics of the foot.

Having conditions such as flat feet, high arches feet made the fascia tissue become overworked or stretched abnormally, resulting in tears and inflammation.

Wearing incorrect shoesShoes that are too worn, thin-soled, loose, lack arch support or lack shock absorption provide inadequate protection of the foot

Frequent use of high heeled shoes shortens the Achilles tendon which stresses the plantar fascia

Overload physical activities or exercisesActivity in sports and regular exercises can place significant stress on the heel and surrounding tissue.

Overload tear of the fascia Plantar Fasciitis

Overweight Weight plays a huge role in damage to the heel.

Since our heels absorb much of our body's pressure when we walk, being overweight can easily lead to damage and plantar fasciitis.

Pregnancy can also add a few extra pounds. However, the hormonal changes in pregnant women can also cause ligaments and other tissue to relax and become more pliable could lead to plantar fasciitis

Age Age also plays a factor.

As we age, tissue tends to become weaker and more prone to damage.

Spur A bony prominence or spur may develop at the attachment of the plantar fascia to the calcaneus.

Spur is an ossification and calcification resulting from traction of the plantar fascia upon the periosteum and occur commonly without pain.

A spur is probably a coincidental finding as they are often found in asymptomatic feet and often not found in patient with symptom

Differential DiagnosisMortons NeuromaSesamoiditis

The characteristic pain on dorsiflexion of the toes associated with plantar fasciitis should help distinguish these painful condition of the foot.Treatment Resting : prolonged and continued irritation can delay the healing process

Stretching and Strengthening Exercises: muscles and tendon stretching and also strengthening of the intrinsic muscles can improve biomechanics of the foot and reduce stress Pain and Inflammation managementIce cube massage 2-3 times/day for 5 minAnti inflammation and analgeticsSurgical treatment if necessary, e.g. plantar fasciitis because of spur Improve foot biomechanicsUse of well fitting, appropriate shoes Night splint

Stretching and Strengthening Exercise

Thank You

Local InjectionSiteSyringeNeedleAnestheticCorticosteroidHydrocortisone equivalents per injection (mg)Plantar fascia5 mL25 gauge, 1.5 inch2 mL of 1% lidocaine (Xylocaine) or 0.25% or 0.5% bupivacaine (Marcaine)1 mL of Celestone*150or1 mL of 40 mg per mL of methylprednisolone (Solumedrol)200The patient is placed in the lateral recumbent position with the affected side down. The physician identifies the medial aspect of the foot and palpates the soft tissue just distal to the calcaneus, locating the point of maximal tenderness or swelling.The needle should be inserted directly down past the midline of the width of the foot. The physician should avoid injecting through the base of the foot, because this approach can result in the complications of pharmaceutical leakage and fat pad atrophy.

The patient should remain in the supine position for several minutes after the injection. The patient should remain in the office for 30 minutes after the injection to be monitored for adverse reactions. In general, patients should avoid any strenuous activity involving the injected region for at least 48 hours. Patients should be cautioned that they may experience worsening symptoms during the first 24 to 48 hours. This is related to a possible steroid flair, which can be treated with ice and NSAIDs (e.g., ibuprofen, naproxen). A follow-up examination within three weeks should be arranged