Fasciitis

Fasciitis is inflammation of the fascia, a sheet-like connective tissue that surrounds muscles, nerves, and vessels. While fasciitis can affect fascia throughout the body, the term is most commonly applied to plantar fasciitis, inflammation of the plantar fascia in the foot.

Causes and context vary. Fasciitis can result from overuse, repetitive strain, acute injury, aging, or biomechanical factors such as flat feet or high arches. It may also occur with systemic inflammatory or autoimmune conditions, infection, or after surgery in rare cases. Diagnosis is usually clinical, based on history and exam, with imaging used to rule out other conditions or to assess the fascia when necessary.

Symptoms depend on the site but typically include localized pain and tenderness along the fascia, stiffness, and functional limitation. Plantar fasciitis presents as sharp heel pain, often worse with the first steps after waking or after prolonged rest, improving with activity but sometimes returning after prolonged standing or running.

Diagnosis and differential considerations. Imaging such as ultrasound or MRI can reveal fascial thickening or edema in some cases; X-ray may help exclude other causes such as bone lesions or calcaneal spurs. Differential diagnoses include Achilles tendinopathy, stress fracture, nerve entrapment, cellulitis, and, in severe cases, necrotizing fasciitis (a medical emergency).

Treatment and prognosis. Most fasciitis cases respond to conservative management: rest or activity modification, ice, nonsteroidal anti-inflammatory drugs, and physical therapy with targeted stretching and strengthening. Footwear modifications, orthotics, and night splints can help. Corticosteroid injections are used cautiously due to rupture risk; surgery is rare and reserved for refractory plantar fasciitis. The prognosis is variable; many patients improve over weeks to months, while a minority develop chronic symptoms. Prevention focuses on proper footwear, gradual activity increases, and regular stretching.