A 38-year-old woman complains of burning pain under the heel, worst on first steps in the morning and after prolonged standing. X-ray shows a plantar calcaneal spur. The primary pathological process in plantar fasciitis is:

• A Inflammatory arthritis of the subtalar joint
• B Stress fracture of the calcaneus at the spur
• C Degenerative (non-inflammatory) microtearing and neovascularisation of the plantar fascia at its calcaneal insertion — a fasciosis ✓
• D Peripheral neuropathy of the medial plantar nerve

Explanation

Plantar fasciitis, now more accurately termed plantar fasciosis, is primarily a degenerative condition characterised by micro-tears, collagen disarray, and neovascularisation at the calcaneal enthesis — not an inflammatory process with immune cells. The calcaneal spur is a reactive bony change and is not the cause of pain. First-line management includes stretching exercises (calf and plantar fascia), orthotic insoles, and NSAIDs for 3–6 months before considering shockwave therapy or corticosteroid injection.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.