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Inferior heel pain
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Dishan Singh, Shelain Patel, Karan Malhotra
Plantar fasciitis is the most common condition affecting the plantar fascia, although the term is a misnomer since histological examination in symptomatic patients show degeneration rather than inflammation. Excessive, repetitive strain at the origin leads to microtears of the fascial enthesis with subsequent inhibition of normal reparative processes causing fibre disorientation, increased mucoid ground substance, angiofibroblastic hyperplasia and calcification (8). This excessive load means fasciitis is thus more frequently observed in three patient groups: obese patients, runners and people whose occupation involves prolonged standing. A tight posterior muscular chain (hamstrings and gastrocnemius-soleus complex) has also been observed more frequently in patients with plantar fasciitis. These conditions contribute to greater forefoot loading which increases strain on the plantar fascia through the windlass mechanism.
Foot and ankle
Published in Pankaj Sharma, Nicola Maffulli, Practice Questions in Trauma and Orthopaedics for the FRCS, 2017
Pankaj Sharma, Nicola Maffulli
Plantar fasciitis is a degenerative condition of the plantar fascia, rather than an inflammatory condition. Physiotherapy to stretch the plantar fascia, and patient education along with footwear modification are appropriate first-line management for this condition. Around 80% of cases resolve spontaneously within 12 months. Only 5% of patients require surgical release when non-operative measures fail.
The ankle and foot
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Patients may lose heart and demand that something be done. However, there is no reliable surgical procedure for this condition. Limited fasciotomy to release part of the plantar fascia can help in some cases, but there is a significant risk of complications including worsening of the condition. Where the driving force behind the condition is tightness of the gastrocnemius muscle, a surgical recession of that muscle can be of benefit. Promising new interventions include shockwave lithotripsy and localized radiofrequency (coblation) therapy, but these have yet to be fully tested in rigorous and large-scale studies.
Effects of dry needling and stretching exercise versus stretching exercise only on pain intensity, function, and sonographic characteristics of plantar fascia in the subjects with plantar fasciitis: a parallel single-blinded randomized controlled trial
Published in Physiotherapy Theory and Practice, 2023
Saman Salehi, Azadeh Shadmehr, Gholamreza Olyaei, Siamak Bashardoust, Seyed Mohsen Mir
In conclusion, this investigation demonstrated that the combination of dry needling and stretching exercises could be an effective intervention for subjects with PF. The triad of results based on per-protocol analysis including statistical significance, high efficacy according to the Cohen’s d effect size, and the existence of clinical significance (mean difference ≥ MCID) showed, compared to the stretching exercise only, the combination of dry needling and stretching exercises not only significantly improved first step pain, pain and level of function in ADL but also caused significant changes in ultrasonographic features of the plantar fascia. However, many questions still remain to be answered in this field. Further studies could assess these interventions’ long-term effects on foot pain, function, and ultrasonographic features of the plantar fascia.
Innovative treatment for pes cavovarus: a pilot study of 13 children
Published in Acta Orthopaedica, 2018
Ignacio Sanpera Jr, Guillem Frontera-Juan, Julia Sanpera-Iglesias, Laura Corominas-Frances
At the level of the internal tuberosity of the os calcis, on the medial foot border, a 2-centimeter incision was made (Figure 4) in an oblique fashion following the inferior border of the calcaneum. The fibers of the plantar fascia and the foot sole muscles were identified by a blunt instrument and percutaneously sectioned. A periosteal elevator was then introduced through the hole and used to disinsert any possible remaining fibers.
Finite element method based parametric study of Gastrocnemius-soleus recession: implications to the treatment of midfoot-forefoot overload syndrome
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Miko Lin Lv, Haowei Zhang, Liang Chen, Ying Liu, Fei Wang, Duo Wai-Chi Wong, Li Sun, Ming Ni
The manifestation of midfoot-forefoot overload syndrome is attributed to the anatomical configurations between the plantar fascia and the Achilles tendon that attaches the gastrocnemius and soleus to the calcaneus. Based on corpse experiments, some researchers found that the distribution of plantar pressure would be mainly affected by triceps contracture of the lower limb, which would transfer plantar pressure from the hind foot to the forefoot (Ward et al. 1998; Abdulmassih et al. 2013), causing changes in the biomechanical environment of the lower extremity, and thus inducing other pathologies (Maskill et al. 2010). Myers (2014) pointed out that the plantar fascia and Achilles tendon were indeed ‘linked’. The plantar fascia is attached to the periosteum of the calcaneus, which acts as a wrapping on the heel bone, runs posteriorly, and forms the collagenous network rooted by the Achilles tendon. There was a significant correlation between the thickness of plantar fascia and the Achilles paratenon (Stecco et al. 2013), while the tension of plantar fascia was also found to be positively correlated with the loading of Achilles tendon (Carlson et al. 2000). Thus, tightness or contracture of Achilles tendon or posterior leg muscles (gastrocnemius and soleus) was regarded as one of the risk factors of plantar fasciitis (Carlson et al. 2000; Nakale et al. 2018). More than 80% of plantar fasciitis patients presented equinus contracture problems (Patel and DiGiovanni 2011). Moreover, the high tension of plantar fascia caused by the equinus contracture induced excessive pressure and overload on the forefoot during gait that led to pain, deformity, and a spectrum of foot and ankle problems (Maskill et al. 2010; Schmal et al. 2018). Gastrocnemius-soleus recession was proven to relieve forefoot plantar pressure that alleviated the midfoot-forefoot overload syndrome (Greenhagen et al. 2010), while the effectiveness of the procedure on relieving plantar fascia tension requires further investigation.