Foot Care from A to Z

Thomas P. Lyman, BS; Tracey C. Vlahovic, DPM, FAPWCA

Disclosures

Dermatology Nursing 

In This Article

Plantar Fasciitis

Plantar fasciitis, or heel pain, is the chief complaint of 10%-15% of adults seen by podiatric physicians. The classic sign is "first step pain," which occurs on the first step when getting out of bed in the morning. Pain is most commonly noted near the medial attachment of the plantar fascia on the calcaneus, but the patient may also complain of Achilles insertional pain. Ankle equinus or a tight Achilles tendon often precedes the heel pain and is believed to be part of the cause. Initial treatments are arch supports, taping, orthotics, stretching the Achilles tendon, night splints, and/or injection therapy with corticosteroid. Historically, pain was associated with a heel spur on radiographs; however, now there is little correlation to the presence of the spur and pain. The resulting spurring seen on the plantar aspect of the calcaneus is a result of Wolff's Law and generally is not surgically excised. Wolff's Law is the physiologic principle that bone in a healthy person will respond to the load it is placed under. In the case of heel pain, it is believed the plantar fascia pulls on the plantar aspect of the calcaneus which results in the formation of the spur. Thus, surgical correction involves excising the medial one-third of the plantar fascia from its origin, and not heel spur removal (Fishco, Goecker, & Schwartz, 2000; Kalaci et al., 2009; Martin et al., 2001).

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