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Plantar fasciitis

Also known as plantar aponeurosis or a heel spur

Fasciite plantaire

What is it?

Plantar fasciitis, also known as plantar aponeurosis or a heel spur, is a painful condition affecting the plantar area of the heel. It is the primary cause of talagia or heel pain. It is an inflammation of the plantar fascia – a fibrous band of tissue extending from the calcaneus to the toes and involved in the arched shape of the foot. Like many tendon disorders, it results from a repetitive strain injury.

Over time, a heel spur will often develop. This heel spur is, in fact, a calcification of the plantar fascia and reflects the chronic nature of the condition. The name erroneously suggests that the spur is the main cause of pain while it actually reflects a more serious condition whose discomfort can at times be extremely disabling. The condition is mainly caused by degenerative ligament damage.

There are many causes for this condition; however, it is generally associated with a shortening of the posterior structures (i.e. the calf muscles). The anatomical and mechanical link between the posterior muscles and the fascia result in chronic overloading at its insertion point, causing local micro-lesions and ultimately pain.

Being overweight, wearing unsuitable shoes, repeatedly walking on hard floors, chronic systemic inflammations, having flat feet/high arches or sports injuries are other possible causes of fasciitis.

fasciite plantaire et épine calcanéenne
  • Fig. 1

    Injury at the insertion of the fascia and development of a bony “spur”.

Clinical presentation

Plantar fasciitis is characterised by pain in the heel that can sometimes be severe and very disabling. Patients usually describe a burning sensation originating precisely at the insertion of the fascia on the calcaneus. Pain is greater in the morning and when standing for prolonged periods; it improves when resting or after taking the first few steps in the morning. Over time and as the condition progresses, pain becomes increasingly frequent and, eventually, systematic whenever placing a load on the lower limb.

A second painful site is sometimes observed, located right under the internal malleolus, with a sensation of compression. This is a compressive syndrome affecting a nerve branch (Baxter’s nerve impingement) and when it is one of the clinical symptoms, will require specific treatment.

When should you consult a specialist?

When the heel pain does not go away easily or when repeated pain occurs, it is advisable to consult a specialist. Experience has shown that the time it takes to heal this condition is commensurate to the duration of the condition; that is to say, the sooner the condition is treated, the greater the chances of healing will be.

As long as the cause of the condition has not been identified, the problem may potentially recur. It is therefore very important to have a specialised medical examination. X-rays or MRI may be requested, but the diagnosis is mainly clinical.

At present, no studies have demonstrated the superiority of one line of treatment compared with others, and the treatment options must be followed in stages to find the best solution for each patient.

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