Figure. Lateral radiograph of the left foot.
A 40-year-old man presents with a 6-month history of pain in his left heel. He works as a mechanic and often experiences pain while working. The patient notes that the pain is worse in the morning when he first gets out of bed, and oral nonsteroidal anti-inflammatory drugs (NSAIDs) do not help relieve the pain. Lateral radiograph of the left foot is obtained (Figure), and plantar fasciitis is suspected.
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Plantar fasciitis is a common cause of foot pain that affects both men and women equally. The condition is more frequently seen among athletes but can occur in patients who engage in activity at any level, including those with a more sedentary lifestyle.
The diagnosis of plantar fasciitis is based on history and physical examination findings; diagnostic imaging is usually not helpful in establishing a diagnosis. Heel spurs are frequently seen on radiographs but are not a cause of plantar fasciitis nor is a spur a risk factor for developing the condition. This is important to note as many patients falsely believe that removing the spur will cure plantar fasciitis.
Limited ankle dorsiflexion (tight heel cord), increased body mass index (BMI >30 kg/m2), and having a job that requires prolonged standing significantly increases the risk of developing plantar fasciitis.1 However, the strongest indicator for developing the condition is having a tight heel cord. The ankle requires at least 10° of dorsiflexion during gait and tight heel cords limit this motion. The foot compensates for this lack of movement with excessive pronation that increases tension on the plantar aponeurosis (plantar fascia). Patients who are obese and/or stand at work place more force on the plantar aponeurosis, which contributes to inflammation and pain.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants.
1. Riddle DL, Pulisic MT, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85(5):872-877.
2. Aiyer A. Plantar fasciitis. Ortho Bullets website. https://www.orthobullets.com/foot-and-ankle/7025/plantar-fasciitis?expandLeftMenu=true. Updated June 10, 2019. Accessed February 3, 2020.