Latt L Daniel, Jaffe David Eric, Tang Yunting, Taljanovic Mihra S
University of Arizona, Tucson, AZ, USA.
OrthoArizona-Arizona Bone and Joint Specialists, Scottsdale, AZ, USA.
Foot Ankle Orthop. 2020 Feb 13;5(1):2473011419896763. doi: 10.1177/2473011419896763. eCollection 2020 Jan.
Plantar fasciitis is the most common cause of chronic heel pain in adults, affecting both young active patients and older sedentary individuals. It results from repetitive stress to the plantar fascia at its origin on the medial tubercle of the calcaneus and is often associated with gastrocnemius tightness. The diagnosis can be made clinically with a focused history and physical examination; imaging is reserved for atypical presentations and those that do not respond to initial treatment. The most common presenting symptom is aching plantar heel pain, which is worst with first step in the morning or after periods of rest. Diagnosis is confirmed with point tenderness at the origin of the plantar fascia on the medial tubercle of the calcaneus. Initial treatment consists of activity modification, anti-inflammatory medication, gastrocnemius and plantar fascia stretching, and an in-shoe orthosis that lifts and cushions the heel. These nonoperative treatments lead to complete resolution of pain in 90% of patients but can take 3-6 months. Patients who remain symptomatic despite a 6-month trial of nonoperative therapy may be considered for minimally invasive treatment or surgery. Platelet-rich plasma injections and therapeutic ultrasound are among a number of minimally invasive treatments that stimulate the body's healing response. Corticosteroid injections temporarily relieve pain, but may increase the risk of plantar fascia rupture and fat pad atrophy. Botulinum toxin injections relax the calf muscles, which decreases the stress in the plantar fascia. Operative treatments include gastrocnemius recession and medial head of gastrocnemius release, which decrease the stress on the plantar fascia and partial planter fasciotomy, which stimulates a healing response.
Level V, expert opinion.
足底筋膜炎是成人慢性足跟痛最常见的原因，影响年轻活跃患者和年长久坐个体。它是由于跟骨内侧结节处足底筋膜起点反复受到应力所致，常与腓肠肌紧张有关。临床诊断可通过重点病史询问和体格检查做出；影像学检查适用于非典型表现及对初始治疗无反应的情况。最常见的症状是足底足跟疼痛，早晨第一步或休息一段时间后最为严重。跟骨内侧结节处足底筋膜起点有压痛可确诊。初始治疗包括调整活动、使用抗炎药物、拉伸腓肠肌和足底筋膜，以及使用能抬高和缓冲足跟的鞋垫。这些非手术治疗可使90%的患者疼痛完全缓解，但可能需要3至6个月。经过6个月非手术治疗仍有症状的患者可考虑微创治疗或手术。富血小板血浆注射和治疗性超声是多种刺激身体愈合反应的微创治疗方法。皮质类固醇注射可暂时缓解疼痛，但可能增加足底筋膜破裂和脂肪垫萎缩的风险。肉毒杆菌毒素注射可放松小腿肌肉，从而减轻足底筋膜的应力。手术治疗包括腓肠肌松解术和腓肠肌内侧头松解术，可减轻足底筋膜的应力，以及部分足底筋膜切开术，可刺激愈合反应。
V级，专家意见。
