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Plantar Fascia Injury
Corrie M. Yablon, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Plantar fascia is aponeurosis supporting plantar arch
              • Originates at calcaneal tuberosity, extends to plantar surfaces of metatarsal heads
            • Plantar fascia composed of 3 cords or bands
              • Central band supports flexor digitorum brevis muscle
              • Lateral band supports abductor digiti minimi (a.k.a. abductor digiti quinti) muscle
              • Medial band supports abductor hallucis muscle
            • Plantar fasciitis
              • Plantar fasciitis is misnomer
                • Actually degenerative process; some authors use term fasciosis or fasciopathy
              • Clinical condition of painful, chronic thickening of plantar fascia > 4 mm
            • Plantar fascia rupture
              • Discontinuity or tear of plantar fascia
              • Degenerative tears usually involve central band near calcaneus
              • Traumatic tears usually 2-3 cm distal to origin from calcaneus

          IMAGING

          • General Features

            • Radiographic Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Relevant Anatomy

                          CLINICAL ISSUES

                          • Presentation

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                Selected References

                                1. Jiménez-Pérez AE et al: Clinical and imaging effects of corticosteroids and platelet-rich plasma for the treatment of chronic plantar fasciitis: a comparative non randomized prospective study. Foot Ankle Surg. 25(3):354-60, 2019
                                2. David JA et al: Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database Syst Rev. 6:CD009348, 2017
                                3. Gurcay E et al: Shall we inject superficial or deep to the plantar fascia? An ultrasound study of the treatment of chronic plantar fasciitis. J Foot Ankle Surg. 56(4):783-7, 2017
                                4. Celik D et al: Joint mobilization and stretching exercise vs steroid injection in the treatment of plantar fasciitis: a randomized controlled study. Foot Ankle Int. 37(2):150-6, 2016
                                5. Beeson P: Plantar fasciopathy: revisiting the risk factors. Foot Ankle Surg. 20(3):160-5, 2014
                                6. Ehrmann C et al: Calcaneal attachment of the plantar fascia: MR findings in asymptomatic volunteers. Radiology. 272(3):807-14, 2014
                                7. League AC: Current concepts review: plantar fasciitis. Foot Ankle Int. 29(3):358-66, 2008
                                8. Neufeld SK et al: Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg. 16(6):338-46, 2008
                                9. Abreu MR et al: Plantar calcaneal enthesophytes: new observations regarding sites of origin based on radiographic, MR imaging, anatomic, and paleopathologic analysis. Skeletal Radiol. 32(1):13-21, 2003
                                10. Vohra PK et al: Ultrasonographic evaluation of plantar fascia bands. A retrospective study of 211 symptomatic feet. J Am Podiatr Med Assoc. 92(8):444-9, 2002
                                11. Theodorou DJ et al: Disorders of the plantar aponeurosis: a spectrum of MR imaging findings. AJR Am J Roentgenol. 176(1):97-104, 2001
                                12. Theodorou DJ et al: Plantar fasciitis and fascial rupture: MR imaging findings in 26 patients supplemented with anatomic data in cadavers. Radiographics. 20 Spec No:S181-97, 2000
                                13. Grasel RP et al: MR imaging of plantar fasciitis: edema, tears, and occult marrow abnormalities correlated with outcome. AJR Am J Roentgenol. 173(3):699-701, 1999
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Top Differential Diagnoses

                                      • Diagnostic Checklist

                                        TERMINOLOGY

                                        • Definitions

                                          • Plantar fascia is aponeurosis supporting plantar arch
                                            • Originates at calcaneal tuberosity, extends to plantar surfaces of metatarsal heads
                                          • Plantar fascia composed of 3 cords or bands
                                            • Central band supports flexor digitorum brevis muscle
                                            • Lateral band supports abductor digiti minimi (a.k.a. abductor digiti quinti) muscle
                                            • Medial band supports abductor hallucis muscle
                                          • Plantar fasciitis
                                            • Plantar fasciitis is misnomer
                                              • Actually degenerative process; some authors use term fasciosis or fasciopathy
                                            • Clinical condition of painful, chronic thickening of plantar fascia > 4 mm
                                          • Plantar fascia rupture
                                            • Discontinuity or tear of plantar fascia
                                            • Degenerative tears usually involve central band near calcaneus
                                            • Traumatic tears usually 2-3 cm distal to origin from calcaneus

                                        IMAGING

                                        • General Features

                                          • Radiographic Findings

                                            • MR Findings

                                              • Ultrasonographic Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      • Relevant Anatomy

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Consider

                                                              Selected References

                                                              1. Jiménez-Pérez AE et al: Clinical and imaging effects of corticosteroids and platelet-rich plasma for the treatment of chronic plantar fasciitis: a comparative non randomized prospective study. Foot Ankle Surg. 25(3):354-60, 2019
                                                              2. David JA et al: Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database Syst Rev. 6:CD009348, 2017
                                                              3. Gurcay E et al: Shall we inject superficial or deep to the plantar fascia? An ultrasound study of the treatment of chronic plantar fasciitis. J Foot Ankle Surg. 56(4):783-7, 2017
                                                              4. Celik D et al: Joint mobilization and stretching exercise vs steroid injection in the treatment of plantar fasciitis: a randomized controlled study. Foot Ankle Int. 37(2):150-6, 2016
                                                              5. Beeson P: Plantar fasciopathy: revisiting the risk factors. Foot Ankle Surg. 20(3):160-5, 2014
                                                              6. Ehrmann C et al: Calcaneal attachment of the plantar fascia: MR findings in asymptomatic volunteers. Radiology. 272(3):807-14, 2014
                                                              7. League AC: Current concepts review: plantar fasciitis. Foot Ankle Int. 29(3):358-66, 2008
                                                              8. Neufeld SK et al: Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg. 16(6):338-46, 2008
                                                              9. Abreu MR et al: Plantar calcaneal enthesophytes: new observations regarding sites of origin based on radiographic, MR imaging, anatomic, and paleopathologic analysis. Skeletal Radiol. 32(1):13-21, 2003
                                                              10. Vohra PK et al: Ultrasonographic evaluation of plantar fascia bands. A retrospective study of 211 symptomatic feet. J Am Podiatr Med Assoc. 92(8):444-9, 2002
                                                              11. Theodorou DJ et al: Disorders of the plantar aponeurosis: a spectrum of MR imaging findings. AJR Am J Roentgenol. 176(1):97-104, 2001
                                                              12. Theodorou DJ et al: Plantar fasciitis and fascial rupture: MR imaging findings in 26 patients supplemented with anatomic data in cadavers. Radiographics. 20 Spec No:S181-97, 2000
                                                              13. Grasel RP et al: MR imaging of plantar fasciitis: edema, tears, and occult marrow abnormalities correlated with outcome. AJR Am J Roentgenol. 173(3):699-701, 1999