Plantar fascia pathologies
- Calcaneal spur
- Plantar fasciitis
- Plantar fascia rupture
The plantar fascia is a formation inserted at the back of the heel bone (calcaneum), and anteriorly at the base of the toes. It allows the pressures’ distribution during walking, has a role of shock absorber, and opposes the falling of the foot’s longitudinal arch.
It is highly solicited by sports, especially in athletics, marathons, football, dance … It’s tear particularly happens in judo and karate.
Chronic lesions take are calcaneal spur or plantar fasciitis. They usually manifest with heel pain, increasing with weight bearing, at the first step, decreasing with heating, and worsening at the end of the day.
Plantar fasciitis diagnosis
It is confirmed by clinical examination and usually doesn’t require any complementary exam. When stretching the fascia by putting the toes in a dorsal flexion, the plantar fascia appears under the skin. The direct pressure with the practitioner’s finger reproduces the pain. The Achilles tendon must be checked as it’s often simultaneously affected.
Plantar fascia rupture: diagnosis
The patient reports a characteristic foot trauma, usually when landing from a jump, or during an impulse. A snap is often perceived. Pain is very sharp and prevents from walking again just after the trauma. A hematoma, sometimes large, appears on the foot’s arch. This zone becomes extremely sensitive to palpation, which confirms the diagnosis.
A calcaneal spur is sometimes visible on X-rays, but it is not a pathological image. It corresponds to the ossification of a muscle’s insertion on the calcaneus, just above the plantar fascia. It is always wrongly considered responsible for the pain, whereas it is very frequent in patients without any symptom. There is no need to remove it.
In case of doubt or to research an associated pathology, an MRI can be done. It confirms the plantar fascia’s disease: thickening, inflammation, or even rupture.
In most cases, the solution is making orthotic insoles to place in the usual shoes. The aim is to unload the plantar fascia. Therefore, the pordiatrist composes custom-made insoles with specific elements and tries to correct a rear-foot malalignement if present. Heel-shoes are recommended.
Failures of this treatment are extremely rare. Corticoïd injections can be suggested, guided with ultrasound.
Surgery is exceptional and even considered prohibited by some surgeons. If surgery is tried, it consists in sectioning partially the plantar fascia (aponevrotomy). Removing calcaneal spur is never the solution.