EpistemisPlantar fasciitis
Specialty: Musculoskeletal.
Why it occurs
- Mechanical overload due to prolonged standing or long distance running
- Alterations of the plantar arch (flat foot or cavus foot)
- Shortening of the posterior myofascial chain (gastrocnemius and soleus muscles)
- Inappropriate footwear with poor arch support
- Enthesitis in the context of spondyloarthritis (reactive arthritis, ankylosing spondylitis)
- Atrophy of the plantar fat pad (common in the elderly)
Initial workup
High resolution ultrasound of the plantar region (demonstrates thickening of the plantar fascia > 4 mm and areas of hypoechogenicity) | Lateral radiograph of the calcaneus (to rule out stress fractures or evaluate secondary spurs) | Electromyography if concomitant neural entrapment is suspected.
red flags
Diffuse bilateral burning pain that does not improve with rest, associated with paresthesias in the sole of the foot, which worsens at night and extends to the toes (compressive neuropathy of the posterior tibial nerve or tarsal tunnel syndrome).
Standard management
- Meloxicam — 15 mg once daily orally; Systemic anti-inflammatory for initial symptomatic control
- Gabapentin — 300 mg every 8 hours orally, indicated if there is concomitant neuropathic pain
- Perilesional infiltration of triamcinolone acetonide (20-40 mg with local anesthetic, reserved for refractory cases of more than 6 months of evolution).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 3