The Prevalence of Neurological Symptoms in the Presence of Plantar Fasciitis: A Review of 459 Patients

A clinical review was conducted of 459 patients from a large Podiatric Medical practice who presented with a diagnosis of plantar fasciitis, to determine the overall incidence of concomitant neurological symptoms and, if present, their origin. A diagnosis of plantar fasciitis presented clinical neurological findings in 49% (225 of 459) of study patients. With conservative treatment, neurological symptoms resolved in 126 of 225 patients (56%), leaving 99 nonresponding patients having persistent neurological symptoms. Electrodiagnostic studies were obtained in 73 of 99 nonresponding patients. Of those having electrodiagnostic studies, 68 of 73 (93.15%) had positive electrodiagnostic findings, while 5 of the 73 studies performed had no signs of neurological involvement. Of the 68 positive neurological studies, 11.76% (8 of 68) were specific for tarsal tunnel alone; 22.05% (15 of 68) were specific for radiculopathy alone; and 66.17% (45 of 68) of patients had a combination of radiculopathy and tarsal tunnel syndrome. Conservative care treatment in patients with plantar fasciitis alone resulted in plantar heel pain resolution in 87% of study patients. Conservative treatment in the group having plantar fasciitis AND neurological symptoms produced a 75% resolution rate. Using a two-tailed Chi square test, the p value for this comparison was 0.00098 (highly statistically significant). This author believes the 12% decrease in resolution rate of symptoms in the combined symptom group is the associated difficulties found with neurological involvement. In patients with refractory plantar fasciitis, proximal neurological involvement should be highly considered as an etiology for the pain. Surgical correction, based on the MRI and electrodiagnostic findings, would include nerve release along with plantar fascia release.