Plantar Fasciitis
Plantar Fasciitis is the most common cause of heel pain. It is a degenerative condition (fasciosis) of the plantar fascia origin at the medial calcaneal tubercle.
1. Clinical Features
- Start-Up Pain: Severe pain with the first few steps in the morning or after rest (Post-static dyskinesia).
- Site: Medial Calcaneal Tubercle.
- Heel Spur: Found in 50% of patients, but often asymptomatic (incidental finding). The spur is not the cause of pain.
2. Anatomy & Biomechanics
The plantar fascia supports the medial longitudinal arch via the Windlass Mechanism (Toe extension tightens the fascia, raising the arch). Tight Achilles tendon increases strain on the fascia.
3. Management
- Conservative (90%): Stretching (Calf/Fascia), Ice, NSAIDs, Silicone heel cups, Night Splints (keep foot dorsiflexed).
- Advanced: Steroid injection (Risk: Fat pad atrophy/Fascia rupture), Shockwave Therapy (ESWT).
- Surgery: Plantar Fascia Release (Rarely needed).
25 Practice MCQs
Q1. The hallmark symptom of Plantar Fasciitis is:
Answer: A). Fascia tightens overnight; first step stretches inflamed tissue.
Q2. The origin of the plantar fascia is:
Answer: A). The site of maximal tenderness.
Q3. A heel spur is:
Answer: B). Removing the spur is rarely necessary.
Q4. The Windlass Mechanism involves:
Answer: A). Critical for push-off.
Q5. Night splints are used to:
Answer: A). Prevents the fascia from healing in a shortened position.
Q6. Risk factor for Plantar Fasciitis:
Answer: A). Mechanical overload.
Q7. Steroid injection risk includes:
Answer: A). Should be used sparingly.
Q8. Stretching exercises should focus on:
Answer: A). Tight calf drives pronation and strain.
Q9. Is it an inflammatory condition?
Answer: B). Histology shows degeneration, not acute inflammation cells.
Q10. Tarsal Tunnel Syndrome differs by:
Answer: A). Tibial nerve compression.
Q11. Sever's Disease is:
Answer: A). Heel pain in active kids (8-14 years).
Q12. ESWT (Shockwave Therapy) works by:
Answer: A). Effective alternative to surgery.
Q13. Baxter's Nerve entrapment involves:
Answer: A). Causes chronic heel pain mimicking fasciitis.
Q14. Frozen water bottle rolling is used for:
Answer: A). Common home exercise.
Q15. Calcaneal Stress Fracture presents with:
Answer: A). Differentiates from fasciitis (plantar tenderness).
Q16. Pes Planus (Flat foot) predisposes to fasciitis because:
Answer: A). Pes Cavus (High arch) also predisposes due to poor shock absorption.
Q17. Time to resolution with conservative care is:
Answer: B). Patience is required.
Q18. Bilateral heel pain should raise suspicion of:
Answer: A). Especially in young males (Seronegative spondyloarthropathy).
Q19. Silicone heel cups help by:
Answer: A). Shock absorption.
Q20. Platelet Rich Plasma (PRP) is:
Answer: A). Regenerative medicine option.
Q21. Surgical release involves cutting:
Answer: A). Complete release causes arch collapse.
Q22. "Inferior Calcaneal Nerve" entrapment is:
Answer: A). Motor branch to ADM.
Q23. Differential diagnosis "Fat Pad Atrophy" occurs in:
Answer: A). Central heel pain, not medial tubercle.
Q24. Does Ultrasound help in diagnosis?
Answer: A). Useful bedside test.
Q25. The plantar fascia is actually:
Answer: A). Connects calcaneus to phalanges.
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