The plantar fascia is a fibrous band of connective tissue, extending from the calcaneus bone to the tendons of the forefoot and proximal phalanges, which supports the arch of the foot
Plantar fasciitis is caused by the structural breakdown of the fascia in a chronic non-inflammatory degenerative process that involves microtears, collagen breakdown and scarring.
RFs: Age 40-60, obesity, high arched feet, flat feet, excess use (walking, standing, running)
Clinical Features
Gradual onset of sharp heel pain, or pain along the arch of the foot
The pain is most severe after periods of rest, or classically the first few steps after waking
Symptoms then improve with continued walking
Examination:
Pain on palpation of the heel
Positive Windlass test - extension of the 1st MTP reproduces the pain
Morton’s neuroma
Pathophysiology
A benign, thickening of the common digital plantar nerve due to persistent irritation from compression (usually within the third intermetatarsal space).
Clinical Features
Intermittent episodes of forefoot pain, often sharp or burning. Episodes usually last minutes to hours. In chronic cases, pain can become constant.
Altered sensation/numbness/paraesthesia in toes
The sensation of a stone in one’s shoe
Exacerbated by activity
Examination
Pain is reproduced on palpation over the affected metatarsophalangeal space
