Pain on the Plantar Surface of the Foot

Abstract

ain on the plantar surface of the foot subsumes constellations of symptoms arising from various underlying conditions. In this article we present the clinical findings of the diseases that most commonly cause plantar pain, the diagnostic procedures available, and an overview of the treatment options. For reasons of space we restrict ourselves to the two most highly prevalent conditions, plantar fasciitis and metatarsalgia. Methods We carried out a selective survey of the literature in the PubMed database. The search terms were "metatarsalgia", "transfer metatarsalgia," "Morton neuroma," "Freiberg disease," "Freiberg's infraction," "plantar fasciitis," "plantar spur," and "heel pain." We also took account of national and international recommendations and our own experience. Plantar fasciitis Symptoms and clinical picture Patients with plantar fasciitis (PF) complain of pain in the medial plantar part of the heel. The pain occurs when they take the first steps after getting out of bed in the morning or following a period of inactivity. After initial improvement, the pain worsens in the course of the day.

Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain

“…All the above studies demonstrate that the MG experiences greater mechanical loading during daily activities. Clinically, most studies have reported that reduced muscle stiffness can alleviate the symptoms of patients with PF 2,6,9,21 . For example, chronic symptoms lasting longer than 4 months might cause the tissue to be stiffer and to become more difficult to stretch 2 .…”

“…They were recruited from Luoyang Orthopaedic Hospital of Henan Province. The inclusion criteria for the patients with PF were as follows 6,16 : 1. heel pain at the medial plantar, 2. intensity of pain upon being provoked ≥3/10 on a visual analogue scale (VAS), 3. worsening pain when waking up or after a period of rest, 4. pain duration longer than 6 months, 5. not having neuromuscular disease, tendon rupture, musculoskeletal injury of the lower limb or anomaly on ultrasound. Patients who had received any treatment of the ankle or foot, such as steroid injection, shock wave therapy and surgery, were excluded from the study 11,16 .…”

“…The plantar fascia, the major arch-supporting structure of the foot, sustains high levels of stiffness during jumping and running. Previous studies have demonstrated that the gastrocnemius muscle is connected to the plantar fascia by means of the AT 6,7 . Some researchers have also shown that overstretching of the AT, which results from intense muscle contraction, is a plausible mechanical factor for excessive weight-bearing by the plantar fascia.…”

“…Although these methods can provide important information about the MG, LG and plantar fascia, they do not directly quantify muscle stiffness. Recently, most studies have demonstrated that reduced stiffness of the gastrocnemius muscle can alleviate the symptoms of patients with PF and can be achieved by activities such as stretching, massage, specific soft-tissue mobilization, and myofascial release 2,6,9,10 . In addition, our recent study demonstrated that an increase in muscle stiffness was not the same for the individual muscles of the quadriceps in patients with patellar tendinopathy (PT) 11 .…”

Evaluation of the radiotherapeutic management of refractory painful heel spur and plantar fasciitis: a single center experience of 45 years

“…Over a decade after its first description, several therapeutic modalities have been used for the management of painful heel spur and plantar fasciitis. Modification of life style to prioritize resting, losing weight and avoiding from intensive physical workload, analgesics, cold compresses, iontophoresis, antiinflammatory agent and steroid injections, stretching exercises and physical therapy, laser, microwave, ultrasound therapy, orthotics and shoe modifications, foot orthoses and insoles, heel pads, efforts to decrease pressure on the affected site, orthopedic interventions, and radiation therapy (RT) are among the methods for eradicating or alleviating pain from heel spur and plantar fasciitis (8)(9)(10). The use of foot orthoses and insoles may result in functional improvement and reduction of pain from plantar fasciitis and heel spurs (9,10).…”