Nejm 2004;350(21):2159; Phys Sportsmed 2004;32:11

Cause:Overuse, rapid increase in training load or intensity

Pathophys:Repetitive stress leads to microfracture; progresses to fasciosis with dysfunctional inflammatory response

May be athletic or sedentary

Sx:Pain with weight bearing, worse with first steps in morning. May be relieved after some ambulation, then worse with continued weight bearing. Often bilateral, though only one side may be affected on presentation.

Si:Tenderness along plantar fascia, worst plantar medial on calcaneus. Worse with “Windlass test”: dorsiflexion at ankle and extension of toes

Generally self-limiting; most cases resolve spontaneously with rest. Can become chronic

Chronicity. Plantar fascia rupture in small number of cases, causes resolution of symptoms without negative effect on foot biomechanics

Xray:Plain films often show calcaneal spur, which results from the condition. Excising the spur does not help.

Rx:(Response rates in parens.) Activity modification; footwear change (14%) and prefabricated orthoses (95%); dorsiflexion night splints (80%); plantar-specific stretching; corticosteroid injection (70%); surgical plantar release only if all other modalities fail (65-96%). Shock wave ultrasound is new, expensive, and controversial.