SUMMARY OF THE PROPOSAL

Plantar fasciitis, one of the most common causes of heel pain, presents a challenge and treated by health care professionals. It affects both sedentary and athletic people and is thought to result from chronic overload and biomechanical abnormalities either from lifestyle or exercise which results in pain and inflammation of plantar fascia.

The exact cause remains poorly understood. Limited data from case-control studies reveal possible contributing factors of obesity, occupations with prolonged standing, pes planus, pes cavus (high arches) reduced ankle dorsiflexion less than 10°, and inferior calcaneal exostoses (heel spurs). There is a high incidence in runners, and there could be contributions from repetitive micro trauma, faulty running shoes or the running surface, but evidence is limited.

In the case of flatfoot, the subtalar joint remains pronated after foot is flat before mid-stance and midtarsal joint is not locked. (5) When abnormal weight-bearing condition persists and the talocalcaneus joint gets chronically subluxed, the foot cannot support the rigid propulsion for the normal gait cycle. After heel strike during the first half of the stance phase of the gait cycle, the tibia turns inward and the foot excessively pronates to allow flattening of the foot. This mechanism stretches the plantar fascia. As the foot progresses from foot-flat to push-off, the toes dorsiflex and the plantar fascia tightens. As the plantar fascia extends distal to the metatarsal head, tension causes the head to depress and the arch to rise. The plantar fascia pulls on its medial tubercle origin with more effort to create calcaneus inversion in a flatfoot subject with heel valgus. Therefore, the repetitive traction placed on the plantar fascia during walking or running may lead to microtears and inflammatory response.

Historically a broad range of conservative therapies have been used to treat plantar fasciitis. Non-surgical treatment includes rest, heat, ice pack, stretching exercise, foot orthotics, night splinting, taping, topical medications, oral non-steroidal anti-inflammatory drugs (NSAIDs), extracorporeal shock waves, laser, and percutaneous injection with steroids, autologous blood and platelet-rich plasma. Surgical options include release of plantar fascia, ultrasound-guided fasciotomy and co-ablation surgery. Several studies compared various treatment modalities with various degrees of success rate, but there is no clear-cut treatment protocol. For the majority of patients, plantar fasciitis is a self-limiting condition and can be treated effectively by nonsurgical treatments.