Plantar fasciitis is a disorder that causes pain in the heels and soles of the feet. Pain is usually most severe with the first step of the day or after a period of rest. Pain also often occurs by bending the legs and toes toward the shin and may be aggravated by a tight Achilles tendon. Conditions usually come slowly. In about a third of people, both legs are affected.
The cause of plantar fasciitis is not entirely clear. Risk factors include excessive use such as from long standing periods, increased exercise, and obesity. It is also associated with foot rolling and a sedentary lifestyle that involves a bit of exercise. While the heel spurs are often found it is unclear whether they have a role in causing the condition. Plantar fasciitis is a disturbance at the site of ligament insertion in bone marked by micro-tears, collagen damage, and scarring. Because inflammation plays a lower role, the proposed review will be renamed plantar fasciosis. Diagnosis is usually based on signs and symptoms, and ultrasound is sometimes used to help. Other conditions with similar symptoms include osteoarthritis, ankylosing spondylitis, heel pad syndrome, and reactive arthritis.
Most cases of plantar fasciitis heal with time and conservative treatment methods. Usually for the first few weeks, people are advised to rest, change their activities, take pain medication, and stretch. If this is not enough, physiotherapy, orthotics, splinting, or steroid injections may be an option. If other actions are unsuccessful, extracorporeal shock therapy or surgery may be attempted.
Between 4% and 7% of people experience heel pain at any given time, and about 80% of these cases are caused by plantar fasciitis. Approximately 10% of people experience abnormalities at some point during their lifetime. It becomes more common with age. It is not clear whether one gender is more affected than the other.
Video Plantar fasciitis
Signs and symptoms
When plantar fasciitis occurs, the pain is usually sharp and usually unilateral (70% of cases). Heel pain is exacerbated by holding the load on the heel after a long rest. Individuals with plantar fasciitis often report their most intense symptoms during their first step after waking up from bed or after long sitting. Symptom improvement is usually seen by walking on. Rarely, but reported symptoms include numbness, tingling, swelling, or radiating pain. There is usually no fever or night sweats.
If the plantar fascia continues to be excessive in the plantar fasciitis setting, the plantar fascia may rupture. The typical signs and symptoms of plantar fascia rupture include click or fracture, significant local swelling, and acute pain on the sole of the foot.
Maps Plantar fasciitis
Risk factors
Risk factors identified for plantar fasciitis include overdrive, standing on hard surfaces for long periods of time, high leg arches, presence of foot length inequality, and flat feet. The tendency of flat feet to roll in excessively while walking or running makes them more susceptible to plantar fasciitis. Obesity is seen in 70% of individuals present with plantar fasciitis and is an independent risk factor.
Studies have shown a strong association between increased body mass index and plantar fasciitis development in non-athletic populations; the relationship between weight and plantar fasciitis has not been observed in the athletic population. Achilles tendon strain and inappropriate footwear have also been identified as significant risk factors.
Pathophysiology
The causes of plantar fasciitis are poorly understood and suspected to have several contributing factors. The plantar fascia is a fibrous connective tissue band derived from the medial tubercle and the anterior aspect of the heel bone. From there, the fascia extends along the sole of the foot before inserting it at the base of the toe, and supports the arch of the foot.
Initially, plantar fasciitis is believed to be an inflammatory condition of the plantar fascia. However, in the last decade, studies have observed a microscopic anatomical change that suggests that plantar fasciitis is actually caused by damage to the plantar fascial non-inflammatory structure rather than the inflammatory process.
Due to a shift in thinking about the underlying mechanisms on plantar fasciitis, many in the academic community have stated that this condition should be renamed plantar fasciosis. The structural damage to the plantar fascia is believed to be the result of repeated microtrauma (small tears). Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and unorganized collagen fibers.
Disturbances in the normal mechanical movement of plantar fascia during standing and walking (known as the Windlass mechanism) are thought to contribute to the development of plantar fasciitis by placing excess pressure on the calcaneal tuberosity. Other studies have also shown that plantar fasciitis is not actually due to an inflamed plantar fascia, but it may be a tendon injury involving the flexor digitorum brevis muscle located directly to the plantar fascia.
Diagnosis
Plantar fasciitis is usually diagnosed by a health care provider after considering the history of one's presentation, risk factors, and clinical examination. The tenderness for palpation along the inner aspect of the heel bone of the sole of the foot can be obtained during the physical examination. The leg may have limited dorsiflexion due to the tightness of the calf muscles or the Achilles tendon. Dorsiflexion of the foot can cause pain by stretching the plantar fascia with this movement. Diagnostic imaging studies are usually not required to diagnose plantar fasciitis. However, in certain cases a doctor may decide on imaging studies (such as X-rays, diagnostic ultrasound or MRI) necessary to rule out the serious cause of foot pain.
Other diagnoses that are usually considered include fractures, tumors, or systemic diseases if plantar fasciitis pain fails to respond appropriately to conservative medical care. Bilateral heel pain or heel pain in the context of systemic disease may indicate a need for deeper diagnostic investigations. In these circumstances, diagnostic tests such as CBC markers or inflammatory serologies, infections, or autoimmune diseases such as C-reactive protein, blood sedimentation rate, anti-nuclear antibodies, rheumatoid factor, HLA-B27, uric acid or Lyme antibody disease may also be obtained. Neurological deficits can trigger investigations with electromyography to evaluate damage to nerves or muscles.
The incidental findings associated with this condition are heel spur, small bone calcifications on the calcaneus (heel bone), which can be found in up to 50% of those with plantar fasciitis. In such a case, it is an underlying plantar fasciitis that produces heel pain, and is not self-propelled. This condition is responsible for spur creation despite the clinical significance of the heel spurs in plantar fasciitis remains unclear.
Imaging
Medical imaging is not routinely required because it is expensive and does not typically change the way plantar fasciitis is managed. When the diagnosis is not seen clinically, the lateral appearance of x-rays from the ankle is a recommended imaging modality for assessing other causes of heel pain such as stress fractures or bone spur development.
Usually the plantar fascia has three wolves with the thickest central fascicle 4 mm, 2 mm lateral and medial fascicles with a thickness of less than a millimeter. In theory, likelitas fasciitis increases with increasing plantar fascia thickness in calcaneal insertion, with a thickness of more than 4.5 mm which is somewhat useful on ultrasound and 4 mm in MRI. Imaging findings such as plantar aponeurosis thickening, however, may not be present in symptomatic individuals or present in asymptomatic individuals thus limiting the utility of the observations.
A 3-phase bone scan is a sensitive modality for detecting active plantar fasciitis. In addition, a 3-phase bone scan may be used to monitor response to therapy, as indicated by decreased uptake after corticosteroid injection.
Differential diagnosis
The differential diagnosis for broad heel pain and includes pathological entities includes, but is not limited to the following: calcaneal stress fractures, calcaneal bursitis, osteoarthritis, spinal stenosis involving spinal lumbar nerve root 5 (L5) or spinal cord 1 ( S1), kalkaneal lipid syndrome, hypothyroidism, seronegative spondylopathopathies such as reactive arthritis, ankylosing spondylitis, or rheumatoid arthritis (more likely if pain is present on both heels), plantar fascia rupture, and neuropathic compression such as tarsal tunnel syndrome or medial calcaneal nerve replacement.
Determination of plantar fasciitis diagnosis can usually be made based on a medical history and a person's physical examination. In cases where doctors suspect fractures, infections, or some other underlying condition, x-rays may be used to make differential diagnoses. However, and especially for people who stand or walk a lot in the workplace, x-rays should not be used to screen plantar fasciitis unless imaging is indicated otherwise because using it outside of medical guidelines is unnecessary health care.
Treatment
Non-surgical
Approximately 90% of cases of plantar fasciitis will improve within six months with conservative treatment, and within a year without treatment. Many treatments have been proposed for plantar fasciitis. Most have not been adequately investigated and there is little evidence to support recommendations for such treatment. The first-line conservative approach includes rest, heat, ice, and calf reinforcement; techniques for stretching the calf muscles, Achilles tendon, and plantar fascia; weight loss in overweight or obesity; and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. NSAIDs are commonly used to treat plantar fasciitis, but fail to resolve pain in 20% of people.
Extracorporeal shock wave therapy (ESWT) is an effective treatment modality for plantar fasciitis pain that is unresponsive to non-surgical conservative measures for at least three months. Evidence from the meta-analysis showed significant pain relief lasting up to one year after the procedure. However, the debate over the effectiveness of therapy has taken place. ESWT can be performed with or without anesthesia although studies have suggested that this therapy is less effective when anesthesia is given. Complications of ESWT are rare and usually mild when present. Known complications from ESWT include development of mild hematoma or ecchymosis, redness around the site of the procedure, or migraine.
Corticosteroid injections are sometimes used for refractory plantar fasciitis cases for more conservative action. There is transient evidence that injections may be effective for relieving pain in the first month but not afterwards. Foot Orthosis has been shown to be an effective method for reducing plantar fasciitis pain for up to 12 weeks. The long-term effectiveness of custom orthotics for the reduction of plantar fasciitis pain requires additional study. Orthotic devices and certain recording techniques are proposed to reduce foot pronation and therefore reduce the burden on the plantar fascia resulting in increased pain.
Another treatment technique known as plantar ionophthesis involves applying an anti-inflammatory agent such as dexamethasone or acetic acid topically to the foot and transmitting this substance through the skin with an electric current. Moderate evidence exists to support the use of night splints for 1-3 months to relieve plantar fasciitis pain that has lasted for six months. Night splints are designed to position and maintain the ankle in a neutral position so that passively stretch the calf and plantar fascia overnight during sleep.
Surgery
Plantar physiotomy is often considered after conservative treatment fails to resolve the problem after six months and is seen as a last resort. Minimally invasive and endoscopic approaches to plantar fasciotomy exist but require specialists who are familiar with certain equipment. The availability of this surgical technique is currently limited. A 2012 study found that 76% of patients undergoing endoscopic plantar fasciotomy have resolved their symptoms and have multiple complications (level IV evidence). Recovery of the heel spur during plantar fasciotomy has not been found to improve surgical results.
Plantar heel pain can occur for several reasons and the release of the plantal lateral nerve branches can be performed in conjunction with plantar fasciotomy in certain cases. Possible complications of plantar fasciotomy include nerve injury, instability of the medial longitudinal arch, calcaneal fracture, prolonged recovery time, infection, rupture of the plantar fascia, and failure to correct the pain. Surgical rounding has recently been proposed as an alternative surgical approach to treatment of recalcitrant plantar fasciitis.
Unproven care
Botulinum Toxin Injections as well as similar techniques such as platelet-rich plasma injections and prolotherapy are still controversial.
Dry needle punctures are also being studied for the treatment of plantar fasciitis. A systematic review of available research finds limited evidence of effectiveness for this technique. Studies are reported to be inadequate in quality and overly diverse in methodology to allow for definite conclusions.
Epidemiology
Plantar fasciitis is the most common type of plantar fascia injury and is the most common reason for heel pain, responsible for 80% of cases. This condition tends to be more common in women, military recruitment, older athletes, obese, and young male athletes.
Plantar fasciitis is thought to affect 1 in 10 people at some point during their lifetime and most often affects people between 40-60 years. In the United States alone, more than two million people receive treatment for plantar fasciitis. The cost of plantar fasciitis treatment in the United States is estimated at $ 284 million annually.
References
External links
- "Plantar fasciitis dan taji tulang". American Academy of Orthopaedic Surgeons
Source of the article : Wikipedia
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