摘要：Plantar fasciitis is an overuse injury characterized by pain at the medial tubercle of the calcaneus and/or along the medial longitudinal arch of the foot. It usually develops when repetitive and prolonged stress is placed on plantar fascia, which may cause microtears and/or partial or total tears of the fascia near its insertion to the calcaneus. Plantar fascia plays significant role in the foot biomechanics. It absorbs mechanical forces placed on the foot and propels foot forward by utilizing the windlass effect. In deranged foot biomechanics, like in pronation of the foot, pes cavus, shortened Achilles tendon, extreme pes planus, etc., additional stress and elongation of plantar fascia is observed, which the fascia, because of its anatomy, is unable to compensate. In athletes, plantar fasciitis is more common in long distance runners and increased incidence is observed in tennis players, basketball players and in dancers. It is usually unilateral whereas in 15% of patients it is bilateral. Clinical findings include painful foot with pain across the plantar aspect of the calcaneus. Diagnosis is usually made after anamnesis and clinical examination. The most painful spot is located at the medial tubercle of the calcaneus and pain is aggravated by passive stretching of the fascia. X-rays could be useful for diagnosing bony spur (calcar calcanei) and ultrasound and MRI are useful for diagnosing thickened fascia, bursa or rupture. MRI and scintigraphy are also useful for differentiating plantar fasciitis and stress fracture of the calcaneus. For the treatment of the plantar fasciitis, especially in athletes, custom made orthothic devices are used for correction of the deranged foot biomechanics, even for prevention. For conservative treatment all usual methods are used (physiotherapy, cryotherapy, stretching exercises, orthoses through the night, local ultrasound and shock wave therapy and foot taping). Surgical treatment with endoscopic or open methods includes release and complete or partial removal of deranged plantar fascia. Surgical treatment is most commonly performed in athletes after 6-12 months of unsuccessful conservative treatment.
