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Plantar Fasciopathy: A Clinical Review

  • Musculoskeletal Rehabilitation (NA Segal, Section Editor)
  • Published:
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Abstract

Heel pain is the most common type of foot pain. The differential diagnosis for pain in this region is vast, but plantar fasciopathy is thought to be the most common cause for pain in this region. This article will review the anatomy, biomechanics, pathophysiology, history, physical examination, diagnostic imaging, and treatment options available for plantar fasciopathy.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Thomas MJ, Roddy E, Zhang W, Menz HB, Hannan MT, Peat GM. The population prevalence of foot and ankle pain in middle and old age: a systematic review. Pain. 2011;152:2870–80.

    PubMed  Google Scholar 

  2. Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49(3 Suppl):S1–19.

    PubMed  Google Scholar 

  3. •• Hoffman DF, Grothe HL, Bianchi S. Sonographic evaluation of hindfoot disorders. J Ultrasound. 2014;17:141–50. This was a comprehensive review of the sonographic findings of different causes of heel pain, including plantar fasciopathy, plantar fascia tears, Baxter’s neuropathy, plantar fibromatosis, foreign bodies, calcaneal stress fractures, rheumatoid nodules, and plantar vein thrombosis.

    PubMed  PubMed Central  Google Scholar 

  4. Lareau CR, Sawyer GA, Wang JH, DiGiovanni CW. Plantar and medial heel pain: diagnosis and management. J Am Acad Orthop Surg. 2014;22:372–80.

    PubMed  Google Scholar 

  5. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004;25:303–10.

    PubMed  Google Scholar 

  6. Buchbinder R. Clinical practice. Plantar fasciitis. N Engl J Med. 2004;350:2159–66.

    CAS  PubMed  Google Scholar 

  7. Campbell JW, Inman VT. Treatment of plantar fasciitis and calcaneal spurs with the UC-BL shoe insert. Clin Orthop Relat Res. 1974;103:57–62.

    Google Scholar 

  8. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93:234–7.

    PubMed  Google Scholar 

  9. Stecco C, Corradin M, Macchi V, Morra A, Porzionato A, Biz C, et al. Plantar fascia anatomy and its relationship with Achilles tendon and paratenon. J Anat. 2013;223:665–76.

    PubMed  PubMed Central  Google Scholar 

  10. Langevin HM, Huijing PA. Communicating about fascia: history, pitfalls, and recommendations. Int J Ther Massage Bodyw. 2009;2:3–8.

    Google Scholar 

  11. Moraes do Carmo CC, Fonseca de Almeida Melao LI, Valle de Lemos Weber MF, Trudell D, Resnick D. Anatomical features of plantar aponeurosis: cadaveric study using ultrasonography and magnetic resonance imaging. Skelet Radiol. 2008;37:929–35.

    Google Scholar 

  12. Hoffman DF, Nazarian LN, Smith J. Enthesopathy of the lateral cord of the plantar fascia. J Ultrasound. 2014;33:1711–6.

    Google Scholar 

  13. Wearing SC, Smeathers JE, Urry SR, Hennig EM, Hills AP. The pathomechanics of plantar fasciitis. Sports Med. 2006;36:585–611.

    PubMed  Google Scholar 

  14. Hicks JH. The mechanics of the foot. II. The plantar aponeurosis and the arch. J Anat. 1954;88:25–30.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Bolgla LA, Malone TR. Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice. J Athl Train. 2004;39:77–82.

    PubMed  PubMed Central  Google Scholar 

  16. Cheung JT, Zhang M, An KN. Effect of Achilles tendon loading on plantar fascia tension in the standing foot. Clin Biomech (Bristol, Avon). 2006;21:194–203.

    Google Scholar 

  17. Erdemir A, Hamel AJ, Fauth AR, Piazza SJ, Sharkey NA. Dynamic loading of the plantar aponeurosis in walking. J Bone Joint Surg Am. 2004;86-A:546–52.

    Google Scholar 

  18. Berbrayer D, Fredericson M. Update on evidence-based treatments for plantar fasciopathy. PM R. 2014;6:159–69.

    PubMed  Google Scholar 

  19. Jarde O, Diebold P, Havet E, Boulu G, Vernois J. Degenerative lesions of the plantar fascia: surgical treatment by fasciectomy and excision of the heel spur. A report on 38 cases. Acta Orthop Belg. 2003;69:267–74.

    PubMed  Google Scholar 

  20. Snider MP, Clancy WG, McBeath AA. Plantar fascia release for chronic plantar fasciitis in runners. Am J Sports Med. 1983;11:215–9.

    CAS  PubMed  Google Scholar 

  21. •• Beeson P. Plantar fasciopathy: revisiting the risk factors. Foot Ankle Surg. 2014;20:160–5. The authors systematically reviewed the literature for risk factors for plantar fasciopathy. Risk factors were categorized as intrinsic or extrinsic, and further grouped under several subcategories.

    CAS  PubMed  Google Scholar 

  22. Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy. 1998;14:840–3.

    CAS  PubMed  Google Scholar 

  23. Mohseni-Bandpei MA, Nakhaee M, Mousavi ME, Shakourirad A, Safari MR, Vahab Kashani R. Application of ultrasound in the assessment of plantar fascia in patients with plantar fasciitis: a systematic review. Ultrasound Med Biol. 2014;40:1737–54.

    PubMed  Google Scholar 

  24. Neufeld SK, Cerrato R. Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg. 2008;16:338–46.

    PubMed  Google Scholar 

  25. Wolgin M, Cook C, Graham C, Mauldin D. Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int. 1994;15:97–102.

    CAS  PubMed  Google Scholar 

  26. DiGiovanni CW, Kuo R, Tejwani N, Price R, Hansen ST Jr, Cziernecki J, et al. Isolated gastrocnemius tightness. J Bone Joint Surg Am. 2002;84-A:962–70.

    Google Scholar 

  27. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85-A:872–7.

    Google Scholar 

  28. McNally EG, Shetty S. Plantar fascia: imaging diagnosis and guided treatment. Semin Musculoskelet Radiol. 2010;14:334–43.

    PubMed  Google Scholar 

  29. Osborne HR, Breidahl WH, Allison GT. Critical differences in lateral X-rays with and without a diagnosis of plantar fasciitis. J Sci Med Sport. 2006;9:231–7.

    CAS  PubMed  Google Scholar 

  30. DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. 2003;85-A:1270–7.

    Google Scholar 

  31. Porter D, Barrill E, Oneacre K, May BD. The effects of duration and frequency of Achilles tendon stretching on dorsiflexion and outcome in painful heel syndrome: a randomized, blinded, control study. Foot Ankle Int. 2002;23:619–24.

    PubMed  Google Scholar 

  32. Renan-Ordine R, Alburquerque-Sendin F, de Souza DP, Cleland JA, Fernandez-de-Las-Penas C. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2011;41:43–50.

    PubMed  Google Scholar 

  33. Rathleff MS, Molgaard CM, Fredberg U, Kaalund S, Andersen KB, Jensen TT, et al. High-load strength training improves outcome in patients with plantar fasciitis: a randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2014. doi:10.1111/sms.12313.

    Google Scholar 

  34. Podolsky R, Kalichman L. Taping for plantar fasciitis. J Back Musculoskelet Rehabil. 2014. doi:10.3233/BMR-140485.

    PubMed  Google Scholar 

  35. Landorf KB, Radford JA, Keenan AM, Redmond AC. Effectiveness of low-Dye taping for the short-term management of plantar fasciitis. J Am Podiatr Med Assoc. 2005;95:525–30.

    PubMed  Google Scholar 

  36. Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of low-dye taping for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord. 2006;7:64.

    PubMed  PubMed Central  Google Scholar 

  37. Abd El Salam MS, Abd Elhafz YN. Low-dye taping versus medial arch support in managing pain and pain-related disability in patients with plantar fasciitis. Foot Ankle Spec. 2011;4:86–91.

    PubMed  Google Scholar 

  38. Van Lunen B, Cortes N, Andrus T, Walker M, Pasquale M, Onate J. Immediate effects of a heel-pain orthosis and an augmented low-dye taping on plantar pressures and pain in subjects with plantar fasciitis. Clin J Sport Med. 2011;21:474–9.

    PubMed  Google Scholar 

  39. Ha HSHJ, Kim YB, Ha YM, Hwang JM. Immediate clinical and biomechanical effects of low-dye taping in patients with plantar heel pain. Korean J Sports Med. 2012;30:9–15.

    Google Scholar 

  40. Hyland MR, Webber-Gaffney A, Cohen L, Lichtman PT. Randomized controlled trial of calcaneal taping, sham taping, and plantar fascia stretching for the short-term management of plantar heel pain. J Orthop Sports Phys Ther. 2006;36:364–71.

    PubMed  Google Scholar 

  41. Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med. 2006;166:1305–10.

    PubMed  Google Scholar 

  42. Martin JE, Hosch JC, Goforth WP, Murff RT, Lynch DM, Odom RD. Mechanical treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc. 2001;91:55–62.

    CAS  PubMed  Google Scholar 

  43. Baldassin V, Gomes CR, Beraldo PS. Effectiveness of prefabricated and customized foot orthoses made from low-cost foam for noncomplicated plantar fasciitis: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90:701–6.

    PubMed  Google Scholar 

  44. Pfeffer G, Bacchetti P, Deland J, Lewis A, Anderson R, Davis W, et al. Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle Int. 1999;20:214–21.

    CAS  PubMed  Google Scholar 

  45. Al-Bluwi MT, Sadat-Ali M, Al-Habdan IM, Azam MQ. Efficacy of EZStep in the management of plantar fasciitis: a prospective, randomized study. Foot Ankle Spec. 2011;4:218–21.

    PubMed  Google Scholar 

  46. Batt ME, Tanji JL, Skattum N. Plantar fasciitis: a prospective randomized clinical trial of the tension night splint. Clin J Sport Med. 1996;6:158–62.

    CAS  PubMed  Google Scholar 

  47. Probe RA, Baca M, Adams R, Preece C. Night splint treatment for plantar fasciitis. A prospective randomized study. Clin Orthop Relat Res. 1999;368:190–5.

    Google Scholar 

  48. Barry LD, Barry AN, Chen Y. A retrospective study of standing gastrocnemius-soleus stretching versus night splinting in the treatment of plantar fasciitis. J Foot Ankle Surg. 2002;41:221–7.

    PubMed  Google Scholar 

  49. Lee WC, Wong WY, Kung E, Leung AK. Effectiveness of adjustable dorsiflexion night splint in combination with accommodative foot orthosis on plantar fasciitis. J Rehabil Res Dev. 2012;49:1557–64.

    PubMed  Google Scholar 

  50. Yin MC, Ye J, Yao M, Cui XJ, Xia Y, Shen QX, et al. Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. Arch Phys Med Rehabil. 2014;95:1585–93.

    PubMed  Google Scholar 

  51. • Speed C. A systematic review of shockwave therapies in soft tissue conditions: focusing on the evidence. Br J Sports Med. 2014;48:1538–42. The author noted several previous papers have not properly defined the type of shockwave therapy used. Using the author’s categorization, most benefit was found with high dose focused extracorporeal shockwave therapy, and radial pulse therapy.

    PubMed  Google Scholar 

  52. Furey JG. Plantar fasciitis. The painful heel syndrome. J Bone Joint Surg Am. 1975;57:672–3.

    CAS  PubMed  Google Scholar 

  53. Crawford F, Atkins D, Young P, Edwards J. Steroid injection for heel pain: evidence of short-term effectiveness. A randomized controlled trial. Rheumatology (Oxford). 1999;38:974–7.

    CAS  Google Scholar 

  54. Yucel I, Yazici B, Degirmenci E, Erdogmus B, Dogan S. Comparison of ultrasound-, palpation-, and scintigraphy-guided steroid injections in the treatment of plantar fasciitis. Arch Orthop Trauma Surg. 2009;129:695–701.

    PubMed  Google Scholar 

  55. Acevedo JI, Beskin JL. Complications of plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. 1998;19:91–7.

    CAS  PubMed  Google Scholar 

  56. Kim C, Cashdollar MR, Mendicino RW, Catanzariti AR, Fuge L. Incidence of plantar fascia ruptures following corticosteroid injection. Foot Ankle Spec. 2010;3:335–7.

    PubMed  Google Scholar 

  57. Lee HS, Choi YR, Kim SW, Lee JY, Seo JH, Jeong JJ. Risk factors affecting chronic rupture of the plantar fascia. Foot Ankle Int. 2014;35:258–63.

    PubMed  Google Scholar 

  58. Brinks A, Koes BW, Volkers AC, Verhaar JA, Bierma-Zeinstra SM. Adverse effects of extra-articular corticosteroid injections: a systematic review. BMC Musculoskelet Disord. 2010;11:206.

    PubMed  PubMed Central  Google Scholar 

  59. • Maida E, Presley JC, Murthy N, Pawlina W, Smith J. Sonographically guided deep plantar fascia injections: where does the injectate go? J Ultrasound. 2013;32:1451–9. This paper described the three different techniques for performing ultrasound guided plantar fascia injections. The recently described deep plantar fascia injection was investigated in a cadaveric model to determine the injectate distribution. Although this injection method was found to reliably deliver the injectate deep to the plantar fascia, direct contact with the planar fascia was variable due to the intervening flexor digitorum brevis. In addition to this, the injection method was found to reliably distribute over the first branch of the lateral plantar nerve (Baxter nerve).

    PubMed  Google Scholar 

  60. Li Z, Xia C, Yu A, Qi B. Ultrasound-versus palpation-guided injection of corticosteroid for plantar fasciitis: a meta-analysis. PLoS ONE. 2014;9:e92671.

    PubMed  PubMed Central  Google Scholar 

  61. Placzek R, Deuretzbacher G, Buttgereit F, Meiss AL. Treatment of chronic plantar fasciitis with botulinum toxin A: an open case series with a 1 year follow up. Ann Rheum Dis. 2005;64:1659–61.

    CAS  PubMed  PubMed Central  Google Scholar 

  62. Jabbari B, Machado D. Treatment of refractory pain with botulinum toxins—an evidence-based review. Pain Med. 2011;12:1594–606.

    PubMed  Google Scholar 

  63. Huang YC, Wei SH, Wang HK, Lieu FK. Ultrasonographic guided botulinum toxin type A treatment for plantar fasciitis: an outcome-based investigation for treating pain and gait changes. J Rehabil Med. 2010;42:136–40.

    PubMed  Google Scholar 

  64. Babcock MS, Foster L, Pasquina P, Jabbari B. Treatment of pain attributed to plantar fasciitis with botulinum toxin a: a short-term, randomized, placebo-controlled, double-blind study. Am J Phys Med Rehabil. 2005;84:649–54.

    PubMed  Google Scholar 

  65. Elizondo-Rodriguez J, Araujo-Lopez Y, Moreno-Gonzalez JA, Cardenas-Estrada E, Mendoza-Lemus O, Acosta-Olivo C. A comparison of botulinum toxin a and intralesional steroids for the treatment of plantar fasciitis: a randomized, double-blinded study. Foot Ankle Int. 2013;34:8–14.

    PubMed  Google Scholar 

  66. Diaz-Llopis IV, Rodriguez-Ruiz CM, Mulet-Perry S, Mondejar-Gomez FJ, Climent-Barbera JM, Cholbi-Llobel F. Randomized controlled study of the efficacy of the injection of botulinum toxin type A versus corticosteroids in chronic plantar fasciitis: results at one and six months. Clin Rehabil. 2012;26:594–606.

    PubMed  Google Scholar 

  67. Diaz-Llopis IV, Gomez-Gallego D, Mondejar-Gomez FJ, Lopez-Garcia A, Climent-Barbera JM, Rodriguez-Ruiz CM. Botulinum toxin type A in chronic plantar fasciitis: clinical effects one year after injection. Clinical Rehabil. 2013;27:681–5.

    Google Scholar 

  68. Shetty VD, Dhillon M, Hegde C, Jagtap P, Shetty S. A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: a preliminary report. Foot Ankle Surg. 2014;20:10–3.

    PubMed  Google Scholar 

  69. Wilson JJ, Lee KS, Miller AT, Wang S. Platelet-rich plasma for the treatment of chronic plantar fasciopathy in adults: a case series. Foot Ankle Spec. 2014;7:61–7.

    PubMed  Google Scholar 

  70. Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int. 2014;35:313–8.

    PubMed  Google Scholar 

  71. O’Malley MJ, Vosseller JT, Gu Y. Successful use of platelet-rich plasma for chronic plantar fasciitis. HSS J. 2013;9:129–33.

    PubMed  PubMed Central  Google Scholar 

  72. Kumar V, Millar T, Murphy PN, Clough T. The treatment of intractable plantar fasciitis with platelet-rich plasma injection. Foot (Edinb). 2013;23:74–7.

    PubMed  Google Scholar 

  73. Kim E, Lee JH. Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis. PM R. 2014;6:152–8.

    PubMed  Google Scholar 

  74. Martinelli N, Marinozzi A, Carni S, Trovato U, Bianchi A, Denaro V. Platelet-rich plasma injections for chronic plantar fasciitis. Int Orthop. 2013;37:839–42.

    PubMed  Google Scholar 

  75. Ragab EM, Othman AM. Platelets rich plasma for treatment of chronic plantar fasciitis. Arch Orthop Trauma Surg. 2012;132:1065–70.

    PubMed  Google Scholar 

  76. Chew KT, Leong D, Lin CY, Lim KK, Tan B. Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomized trial. PM R. 2013;5:1035–43.

    PubMed  Google Scholar 

  77. Franceschi F, Papalia R, Franceschetti E, Paciotti M, Maffulli N, Denaro V. Platelet-rich plasma injections for chronic plantar fasciopathy: a systematic review. Br Med Bull. 2014 [Epub ahead of print].

  78. Zelen CM, Poka A, Andrews J. Prospective, randomized, blinded, comparative study of injectable micronized dehydrated amniotic/chorionic membrane allograft for plantar fasciitis—a feasibility study. Foot Ankle Int. 2013;34:1332–9.

    PubMed  Google Scholar 

  79. Kumai T, Muneta T, Tsuchiya A, Shiraishi M, Ishizaki Y, Sugimoto K, et al. The short-term effect after a single injection of high-molecular-weight hyaluronic acid in patients with enthesopathies (lateral epicondylitis, patellar tendinopathy, insertional Achilles tendinopathy, and plantar fasciitis): a preliminary study. J Orthop Sci. 2014;19:603–11.

    CAS  PubMed  Google Scholar 

  80. Tomczak RL, Haverstock BD. A retrospective comparison of endoscopic plantar fasciotomy to open plantar fasciotomy with heel spur resection for chronic plantar fasciitis/heel spur syndrome. J Foot Ankle Surg. 1995;34:305–11.

    CAS  PubMed  Google Scholar 

  81. Cheung JT, An KN, Zhang M. Consequences of partial and total plantar fascia release: a finite element study. Foot Ankle Int. 2006;27:125–32.

    PubMed  Google Scholar 

  82. Nery C, Raduan F, Mansur N, Baunfeld D, Del Buono A, Maffulli N. Endoscopic approach for plantar fasciopathy: a long-term retrospective study. Int Orthop. 2013;37:1151–6.

    PubMed  PubMed Central  Google Scholar 

  83. Ohuchi H, Ichikawa K, Shinga K, Hattori S, Yamada S, Takahashi K. Ultrasound-assisted endoscopic partial plantar fascia release. Arthrosc Tech. 2013;2:e227–30.

    PubMed  PubMed Central  Google Scholar 

  84. Conflitti JM, Tarquinio TA. Operative outcome of partial plantar fasciectomy and neurolysis to the nerve of the abductor digiti minimi muscle for recalcitrant plantar fasciitis. Foot Ankle Int. 2004;25:482–7.

    PubMed  Google Scholar 

  85. Monteagudo M, Maceira E, Garcia-Virto V, Canosa R. Chronic plantar fasciitis: plantar fasciotomy versus gastrocnemius recession. Int Orthop. 2013;37:1845–50.

    PubMed  PubMed Central  Google Scholar 

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S. Rajasekaran and J. T. Finnoff both declare no conflicts of interest.

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Correspondence to Sathish Rajasekaran.

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This article is part of the Topical collection on Musculoskeletal Rehabilitation.

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Rajasekaran, S., Finnoff, J.T. Plantar Fasciopathy: A Clinical Review. Curr Phys Med Rehabil Rep 3, 67–76 (2015). https://doi.org/10.1007/s40141-014-0069-7

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