Degenerative condition of the plantar fascia that causes sharp pain on the bottom of the foot pain

Aetiology

• Repetitive stress/overload or degenerative condition

Risk factors

• Physical overload - excessive exercise, excessive weight (obesity)
• Diabetes
• Age - the cushioning heel fat pad atrophies with age
• Abnormal foot shape - splanovalgus or cavovarus
• Frequent walking on hard floors with poor cushioning in shoes

Clinical features

Symptoms

• Start up pain after rest on the instep of the foot (at the origin of the plantar aponeurosis on the distal plantar aspect of the calcaneal tuberosity)
• Pain can be worse after exercise

Signs

• Fullness or swelling on plantarmedial aspect of heel
• Localised tenderness on palpation of the plantar aspect of heel and/or plantarmedial aspect of heel
• Tinel's test positive for Baxter's nerve

Investigations

• Clinical diagnosis

Management