Plantar Fasciitis: (“Heel Spur”)

Presentation

Patients seek help because of gradually increasing inferior heel pain that has progressed to the point of inhibiting their normal daily activities. This fasciitis can develop in anyone who is ambulatory but appears to be more common in athletes (especially runners), those older than 30 years of age, those who stand for prolonged periods of time, and the overweight. There is no defining episode of trauma. The most distinctive clue is exquisite pain in the plantar aspect of the heel when taking the first step in the morning. There is gradual improvement with walking, but as the day progresses, the pain may insidiously increase. First-step pain is also present after the patient has been sitting. The heel is tender to palpation over the medial calcaneal tubercle and may be exacerbated by dorsiflexion of the ankle and toes, particularly the great toe, which creates tension on the plantar fascia. Often the midfascia is tender to palpation, too. There is generally no swelling, heat, or discoloration.