Plantar Fasciitis: Pathology

Very common cause of heel pain, its origin is the source of many debates. Here is a summary of current knowledge

14 March 2016

épine de Lenoir

Heel pain is very common in the active population and in particular among athletes. The most common cause is plantar fasciitis, which is defined as damage to a ligamentous structure located under the foot and attaching to the heel. Long misunderstood, this pathology finally seems to reveal its secrets and its close link with other neighboring structures.

Author: Dr. Adrien Ray

Thorn in Lenoir

Plantar fasciitis, sometimes called Lenoir's thorn, is the main cause of talagias (heel pain) and represents 11-15% of specialized consultations. It corresponds to an attack of the plantar fascia (for more information, read our article ... ). This fascia is a long fibrous structure, connecting the heel to the toes. The term Lenoir's thorn is often used when referring to the injuries of athletes such as basketball players, distance runners or footballers. It usually presents as acute pain, very debilitating, increased by activity and particularly pronounced when waking up. The main risk is the chronization and therefore the installation of these pains on a daily basis. Although the existence of this pathology has been democratized, its origin remains poorly understood. The scientific community agrees to recognize multiple causes, related to many factors such as age, weight or heavy work. The consensus ends there, and the discussions remain passionate about its true nature.

A real inflammatory pathology?

When you find the suffix -ite at the end of a word, it corresponds to an inflammation. Conjunctivitis (conjunctiva), tendinitis (tendon) or sinusitis (sinus) are classic examples. The word fasciitis means "inflammation of a fascia". This pathology has long been considered as such and described as a cascade of inflammatory phenomena due to local stress. However, it is difficult to explain that this "inflammation" does not resorb after a few days of rest, like most acute inflammations. Biopsies have been made on this structure and show little inflammation. Plantar fasciitis is not an inflammatory disease. We must then turn to a degenerative process.

Microtrauma and tissue damage

Studies of Achilles tendon or other tendons have led to a better understanding of the phenomenon responsible for fasciitis. Repeated shocks cause microcracks or tears in the tendinous structures. It is then a delicate balance between the occurrence of these traumas and the ability of the body to heal. As long as the balance is preserved, the foot is painless. When the balance tilts in favor of the traumas, one notes a degeneration of the tissue concerned, a progressive destruction which can lead to a complete rupture and the calcification of the lesions (hence the appearance of a bone spine). Fasciitis is therefore a degenerative and non-inflammatory pathology.

Role of the calf and its contracture

The most exciting discussions about plantar fasciitis or Lenoir's spine are currently focused on the role of the Achilles tendon. The latter is formed by the confluence of two calf muscles: the gastrocnemius and the soleus. These two muscles, very powerful, allow the flexion of the ankle. When the gastrocnemius is too short or too tense (short gastrocnemius syndrome), it leads to a cascade of retractions and in particular that of the plantar fascia. It is therefore intimately linked to the calf by a complex of structure called gastro-calcaneo-plantar system, so dear to the Spanish surgical school. Short gastrocnemius syndrome is common and seems to be responsible for a considerable number of foot pathologies. The DiGiovanni team showed in 2009 that 85% of patients with plantar fasciitis have a calf muscle retraction. These findings show that this very common pathology is perhaps the tip of a much more complex iceberg and that more extensive management should be offered to patients, focusing not only on the fascia, but also on the rest of musculature and statics. To learn more about plantar fasciitis ...