Plantar Fascia

Rupture of the plantar fascia induced by glucocorticoids has usually been reported in athletes. However, a case of spontaneous degenerative rupture has been reported in a 72-year-old man who had received four glucocorticoid injections over 1 year for plantar fasciitis (SEDA-21, 418) (277). 

These fractures are typically subdivided into three types depending on their location. Zone 1 is the cancellous tuberosity, which includes the insertion of the peroneus brevis and abductor digiti minimi tendons and the lateral cord of the plantar fascia. Zone 2 is the distal aspect of the tuberosity and includes dorsal and plantar ligamentous attachments to the fourth metatarsal. Zone 3 comprises the zone distal to the ligamentous attachments to the mid-diaphyseal area. 

RG. 99-5 Facilitated positional release treatment for hypertonicity of the plantar fascia of the left foot. 

Note If the hypertonicity is on the plantar fascia, the monitoring finger is placed at the site on the... 

Plantar fascitis is an inflammation of the plantar fascia of the foot, usually at its insertion on the calcaneus. When chronic in nature, a calcification may develop at the site of insertion of the tendon and a diagnosis of a heel spur is made. 

Finally, an investigation of the effectiveness of ulfrasound-guided corticosteroid injection for the treatment of plantar facilities was conducted by a randomised investigator- and participant-blinded, placebo-controlled trial 82 people with a clinical and ultrasoxmd diagnosis of planfar fasciitis unrelated to systemic inflammatory disease were examined. The participants were randomly allocated to ultrasound-guided injection of the plantar fascia with either 1 ml of 4 mg/ml dexamefhasone sodium phosphate (experimental group) or 1 ml normal saline (placebo) [70 -]. 

Before injection, fhe participants were given an ultrasound-guided posterior tibial nerve block with 2% lidocaine. Primary outcomes were pain, as measured by the foot health status questionnaire (0-100 point scale), and plantar fascia thickness, measured by ultrasoxmd at 4, 8, and 12 weeks. Reduction in pain at 4 weeks favoured the dexa-methasone group by 10.9 points, Between-group differences for pain scores af 8 and 12 weeks were not statistically significant. Plantar fascia thickness measured at 4 weeks favoured the dexamethasone group by -0.35 mm. At 8... 

The number needed to treat with dexamethasone for one successful outcome for pain at 4 weeks was 2.93. There were no reported adverse events associated with the intervention. It could, therefore, be concluded that a single, ultrasoxmd-guided dexamethasone injection is a safe and effective short-term treatment for plantar fasciitis. It provides greater pain relief than placebo at 4 weeks and reduces abnormal swelling of the plantar fascia for up to 3 months. However, clinicians offering this treatment should also note that significant pain relief did not continue beyond 4 weeks. 

A new case of a plantar fascia calcification as sequela of CS injection in the treatment of a plantar fasciitis has been published [34 ]. A 72-year-old woman with severe plantar fasciitis who received a therapeutic CS injection developed a small calcified lump under the skin which subsequently caused ulceration and infection. 

Fox TP, Oliver G, Wek C, Hester T. Plantar fascia calcification a sequelae of corticosteroid injection in the treatment of recalcitrant plantar fasciitis. BMJ Case Rep 2013 2013. http //dx.doi.org/10.1136/bcr-2013-200303. pii bcr2013200303. 

In patients with heel pain, the bony prominences of the calcaneus are palpated in order to reveal tenderness or palpable defects. Patients with plantar fascia enthesopathy complain of localized pain over the inferomedial aspect of the calcaneus, at approxi-... 

The standard US examination of the plantar aspect of the foot is performed with the patient supine and both his/her legs on the bed or placed on a pillow to obtain a more comfortable position. Sagittal images obtained slightly medial to the midline axis of the foot are first obtained over the calcaneal tuberosity to image the preinsertional portion of the plantar fascia. This appears as a distinct thick hyperechoic fibrillar band, somewhat similar to... 

Fig. 17.14. Plantar fascia. Transverse 12-5 MHz US image obtained in the region of midfoot demonstrates the plantar fascia (arrows) as a sharply defined flattened anisotropic band 1-2 mm thick, located superficial to the flexor digitorum brevis muscle (fdb), the quadratus plantae muscle (qp) and the flexor hallucis longus tendon (fht). The photograph at the upper left of the figure indicates probe positioning...

US has a definite role in the management of plantar fasciitis by guiding local injection of steroids (Kane et al. 1998 Tsai et al. 2000b, 2006), extracorporeal shock-wave therapy (Hyer et al. 2005b), or needle fasciotomy (Folman et al. 2005). For steroid injection, both posterior and anterior approaches can be used to direct the needle tip inside the thickened portion of the fascia. Similar to other authors, we prefer to select a posterior approach to inject the plantar fascia (Kane et al. 1998 Tsai et al. 2000). The patient lies prone with the affected foot resting on a triangular pillow to... 

Plantar fascia tears are located at the posterior insertion of the fascia. This condition is most often observed in sportsmen who have sustained forceful plantar flexions. The US appearance of plantar fascia rupture is similar to that of plantar fasciitis and the diagnosis relies mainly on clinical and US findings, including focal nodular swelling and a hypoechoic appearance of the fascia (Fig. 17.33e,f). Surgical fasciotomy exhibits similar characteristics (Yu et al. 1999 Yu 2000). The fascia remains markedly thickened with indistinct superficial and deep margins, probably representing perifascial fibrosis (Fig. 17.35). 

US can assess plantar fascia involvement related to inflammatory disorders, such as spondyloarthropathy (Lehtinen et al. 1994 D Agostino et al. 2003 Borman et al. 2005). Subclinical enthesitis in the feet of these patients is not rare and can easily be detected with US. At gray-scale US and Doppler imaging, the large majority of these patients have at least one sign of active enthesitis that typically presents with symmetric distribution in the extremities. 

Fig. 17.34a-c. Plantar fasciitis and calcaneal enthesophytes. a Long-axis 12-5 MHz US image over the posterior insertion of the plantar fascia with b lateral radiographic and c schematic drawing correlation in a patient with chronic heel pain shows signs of preinsertional fasciitis (open arrow) associated with a prominent enthesophyte (arrowheads) arising from the inferior aspect of the medial tubercle (asterisk). The hyperechoic cortical line (thin arrows) of the calcaneus is typically interrupted and discontinuous due to the anterior projection of the spur... 

Fig. 17.35. Surgical fasciotomy. Long-axis 12-5 MHz US image obtained over the posterior half of the plantar fascia 12 months after open fasciotomy shows a persistent gap (arrowheads) in the plantar fascia (white arrows) filled with hypoechoic tissue (asterisk) suggesting perifascial fibrosis. Note the fasciotomy scar (open arrow) in the subcutaneous fat. C, calcaneus...

Yu JS (2000) Pathologic and postoperative conditions of the plantar fascia review of MR imaging appearances. Skeletal Radiol 29 491-501... 

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