What is Plantar Fascia Syndrome?
Plantar fasciitis (also called plantar fascia syndrome or more accurately plantar fasciopathy) is a chronic degenerative condition of the plantar fascia at its origin on the medial tubercle of the calcaneus, not primarily an inflammatory process, and represents the most common cause of chronic heel pain in adults. 1, 2, 3
Pathophysiology and Terminology
- The condition involves chronic degenerative processes rather than acute inflammation, making "plantar fasciopathy" a more accurate descriptor than "fasciitis" 1, 2
- The pathology results from repetitive stress to the plantar fascia at its calcaneal insertion, often associated with gastrocnemius tightness 3
- The etiology is multifactorial, involving mechanical factors such as repetitive stress and reduced ankle dorsiflexion, as well as links to rheumatologic diseases and genetic factors 1
Clinical Presentation
The hallmark symptom is stabbing, nonradiating pain on the proximal medioplantar surface of the foot that is particularly severe with the first few steps in the morning and worsens at the end of the day. 2, 3
- Pain occurs after periods of rest and improves with initial activity 3
- Physical examination reveals point tenderness at the origin of the plantar fascia on the medial tubercle of the calcaneus 3
- The condition affects both young active patients and older sedentary individuals, with one in 10 people experiencing it in their lifetime 2
Risk Factors
- Limited ankle dorsiflexion 2
- Increased body mass index 2
- Prolonged standing 2
- Occupation-related activity and overexertion 4
- Poor biomechanics and anatomical variations 4
- Common in runners but also affects sedentary individuals 2
Diagnostic Approach
Plantar fasciitis is predominantly a clinical diagnosis based on history and physical examination findings. 2
- Weightbearing radiographs should be the initial imaging study for painful heel, with 85% sensitivity and 95% specificity when combining thickened plantar fascia and fat pad abnormalities 5, 6
- For pain persisting beyond three months despite treatment, ultrasonography is reasonable and inexpensive (80% sensitivity, 88% specificity) 7, 6, 2
- MRI is the most sensitive imaging study for diagnosis and allows accurate characterization of the plantar fascia and adjacent structures 6
- US elastography shows higher diagnostic accuracy (95% sensitivity, 100% specificity) compared to conventional ultrasound (66% sensitivity, 75% specificity) 6
Important Caveat
- MRI findings must be correlated with clinical symptoms to avoid overdiagnosis, as some imaging findings can appear in asymptomatic patients 6