From the Guidelines
Plantar fasciitis symptoms typically present with sharp, stabbing heel pain that is most intense with the first few steps in the morning or after periods of rest, and may be effectively managed with initial treatment options such as open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated) as recommended by the American College of Foot and Ankle Surgeons 1. The pain usually occurs at the bottom of the heel where the plantar fascia attaches to the heel bone, and may decrease after walking for a while but often worsens with prolonged standing or activity. Some patients also experience:
- Heel tenderness when pressure is applied
- Foot arch pain
- Pain that worsens when climbing stairs or standing on tiptoes The pain may develop gradually over time and can affect one or both feet. Symptoms result from inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot connecting the heel bone to the toes, which becomes irritated and inflamed due to repetitive stretching and tearing. Risk factors include:
- Age (40-60 years)
- Certain types of exercise like running
- Obesity
- Foot mechanics such as flat feet or high arches
- Occupations requiring long periods of standing If left untreated, plantar fasciitis can lead to chronic heel pain that interferes with regular activities and potentially cause foot, knee, hip, or back problems due to changes in walking patterns to minimize discomfort. According to the American College of Foot and Ankle Surgeons, if no improvement occurs after six weeks, referral to a podiatric foot and ankle surgeon is appropriate, and additional treatments may be considered 1.
From the Research
Plantar Fasciitis Symptoms
- Plantar fasciitis is characterized by stabbing, nonradiating pain first thing in the morning in the proximal medioplantar surface of the foot, which becomes worse at the end of the day 2
- The pain is typically localized to the proximal plantar fascial insertion at the anteromedial calcaneus, and tenderness to palpation is often the only physical examination finding 2
- Risk factors for plantar fasciitis include limited ankle dorsiflexion, increased body mass index, and standing for prolonged periods of time 2
- Plantar fasciitis can affect both runners and sedentary people, and with proper treatment, 80% of patients improve within 12 months 2
Diagnostic Tools
- Ultrasonography is a reasonable and inexpensive diagnostic tool for patients with pain that persists beyond three months despite treatment 2
- Visual analogue scale (VAS) and Foot Function Index (FFI) are commonly used to evaluate pain and foot function in patients with plantar fasciitis 3, 4
- Foot Health Status Questionnaire (FHSQ) is also used to evaluate foot health in patients with plantar fasciitis 3
Treatment Options
- Treatment for plantar fasciitis typically starts with stretching of the plantar fascia, ice massage, and nonsteroidal anti-inflammatory drugs 2
- Extracorporeal shock wave therapy (ESWT) and custom foot orthotics (CFO) are also effective treatment options, with similar outcomes 3
- Low-level laser therapy (LLLT) has been shown to be more effective than ESWT in reducing pain in plantar fasciitis at short-term follow-up 5
- Corticosteroid injection (CSI), ESWT, and radiofrequency thermal lesioning (RTL) are all safe and effective treatment options, with similar outcomes up to 1 year 6