Dr Jason Lance Crane
FC Ortho (SA) MMED Ortho (Stel)
Heel pain or plantar fasciitis is one of the most common foot complaints seen in an Orthopaedic unit. Plantar fasciitis was first described 40 years ago, but we are no closer in understanding the true etiology of this disease. Theories have been proposed ranging from inflammation to nerve entrapment.
Plantar fasciitis typically occurs in active males between 40 and 70 years old. The Patient usually experiences uni-lateral heel pain (specifically on the anterior medial border of the calcaneal tuberosity) with their first step after getting out of bed, this pain eases after a few steps but re-occurs by the end of the day.
Calcaneal spurs have been previously associated with plantar fasciitis, but 50% of symptom free feet have calcaneal spurs on X-Rays. Plantar Fasciitis is therefore a clinic diagnosis.
Heel pain occurs commonly in rheumatoid arthritis, ankylosing spondylitis, Reiter syndrome, and osteoarthritis. A Deep calcaneal abscess must be ruled out in a diabetic patient.
Conservative management is the treatment of choice, with 90% of patients expected to make a full recovery within 9 months. Treatment consists of anti-inflammatory drugs, a stretching program and orthotics (heel cup during the day and a semi-rigid ankle foot orthosis at night). Local steroid injections are effective, but are painful and increase the risk of plantar fascia rupture.
Surgical management is a last resort and should only be considered after 9 months of failed conservative treatment. Surgery consists of plantar fascia release, plantar nerve release and debridement of the calcaneal spur. This surgery has a high complication rate and is only 90% effective.