Within the last decade, studies have observed microscopic anatomical changes indicating that plantar fasciitis is due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process.Many in the academic community have stated the condition should be renamed plantar fasciosis in light of these newer findings. Repetitive microtrauma (small tears) appears to cause a structural breakdown of the plantar fascia. Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and disorganized collagen fibers.Disruptions in the plantar fascias normal mechanical movement during standing and walking (known as the Windlass mechanism) place excess strain on the calcaneal tuberosity and seem to contribute to the development of plantar fasciitis. Other studies have also suggested that plantar fasciitis is not due to the inflamed plantar fascia but maybe a tendon injury involving the flexor digitorum brevis muscle located immediately deep to the plantar fascia. Diagnosis
Plantar fasciitis is usually diagnosed by a health care provider after consideration of a persons presenting history, risk factors, and clinical examination. Palpation along the inner aspect of the heel bone on the sole may elicit tenderness during the physical examination. The foot may have limited dorsiflexion due to excessive tightness of the calf muscles or the Achilles tendon. Dorsiflexion of the foot may elicit the pain due to stretching of the plantar fascia with this motion. Diagnostic imaging studies are not usually needed to diagnose plantar fasciitis.
Plantar fasciitis or plantar heel pain (PHP) is a disorder of the plantar fascia, which is the connective tissue which supports the arch of the foot. It results in pain in the heel and bottom of the foot that is usually most severe with the first steps of the day or following a period of rest. Pain is also frequently brought on by bending the foot and toes up towards the shin. The pain typically comes on gradually, and it affects both feet in about one-third of cases.The cause of plantar fasciitis is not entirely clear. Risk factors include overuse, such as from long periods of standing, an increase in exercise, and obesity. It is also associated with inward rolling of the foot, a tight Achilles tendon, and a sedentary lifestyle. It is unclear if heel spurs have a role in causing plantar fasciitis even though they are commonly present in people who have the condition. Plantar fasciitis is a disorder of the insertion site of the ligament on the bone characterized by micro tears, breakdown of collagen, and scarring. Since inflammation plays either a lesser or no role, a review proposed it be renamed plantar fasciosis. The presentation of the symptoms is generally the basis for diagnosis; with ultrasound sometimes being useful if there is uncertainty. Other conditions with similar symptoms include osteoarthritis, ankylosing spondylitis, heel pad syndrome, and reactive arthritis.Most cases of plantar fasciitis resolve with time and conservative methods of treatment.