Fortnightly review: Plantar fasciitisBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7101.172 (Published 19 July 1997) Cite this as: BMJ 1997;315:172
- Dishan Singh, senior lecturera,
- John Angel, consultanta,
- George Bentley, professorb,
- Saul G Trevino, associate professorc
- a Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP
- b Institute of Orthopaedics, Royal National Orthopaedic Hospital
- c Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence to: Mr Singh
Plantar fasciitis is the most common cause of inferior heel pain (fig 1). Its aetiology is poorly understood by many, which has led to a confusion in terminology.1 It is said to affect patients between the ages of 8 and 80, but is most common in middle aged women and younger, predominantly male, runners.2
The role of the doctor in the management of plantar fasciitis is to make an appropriate diagnosis and to allow enough time for the condition to run its course, with the aid of supportive measures. If treatment is begun soon after the onset of symptoms, most patients can be cured within six weeks.3
This article is based largely on our experience and recent concepts that have changed our management of inferior heel pain. Reviews written by experts have been supplemented by selected original articles cited in Medline between 1976 and 1995 and published in high quality journals. We used the following keywords for the Medline search: plantar fasciitis, inferior heel pain, heel spur, calcaneodynia.
The plantar fascia is a strong band of white glistening fibres which has an important function in maintaining the medial longitudinal arch: spontaneous rupture or surgical division of the plantar fascia will lead to a flat foot.4 5 The plantar fascia arises predominantly from the medial calcaneal tuberosity on the undersurface of the calcaneus, and its main structure fans out to be inserted through several slips into the plantar plates of the metatarso-phalangeal joints, the bases of the proximal phalanges of the toes and the flexor tendon sheaths.
Just after heel strike during the first half of the stance phase of the gait cycle, the tibia turns inward and the foot pronates to allow flattening of the foot. This stretches the plantar fascia. …