PT on the Net Research

Plantar Fasciitis and Server's Disease


Question:

I was just wondering if you could better explain to me the similarities and differences between plantar fascitis and Sever's disease.

Answer:

Thanks for your question! Let me start by defining each…

Plantar fascia (PF) is dense fascia of the plantar aspect of the foot arising from the calcaneus and inserting in to the base of proximal phalanges. Plantar fasciitis is an overuse condition that arises from irritation and inflammation of the PF. The plantar fascia has a major role in maintaining the longitudinal arch of the foot. In a high arch condition, the PF is shortened and will often cause greater tensile stress on its attachment points as it attempts to absorb shock from the weight of the body. If this condition is severe, it is likely to involve ossification and development of bone spurs at the attachment site (this doesn’t mean a flat foot may not experience similar foot problems).

Server’s disease is inflammation of an apophysis of the heel bone at the insertion of the Achilles tendon. FYI: Apophysis is a tubercle of bone that contributes to its growth but is a point of strong tendinous insertion rather than part of the joint.

I don’t want to assume, but you're probably asking this question because your client expressed he/she has Server’s disease, and it sounds a lot like PF. If my guess is correct, then there’s a strong chance he/she could have both (along with a lot of other problems). My point is, although often diagnosed with a problem, the cause is usually surrounding. So, when a boney overgrowth is seen, you can bet that the surrounding soft tissues are involved - even though the doctors didn’t diagnose it (their specialty may not be in kinetic chain anatomy). Your job is to obey what the doctor says and, in parallel, improve the overall function of your client so the structural change only improves.

In summary, Server’s disease is from the top down and PF is bottom up, relative to the heel!