From the Guidelines
Plantar fasciitis typically presents with sharp, stabbing heel pain that is most intense with the first few steps in the morning or after periods of rest, and the initial imaging study should be radiography, as it is useful to distinguish among different causes of chronic foot pain and has a sensitivity of 85% and a specificity of 95% for plantar fasciitis 1.
Key Symptoms
- Sharp, stabbing heel pain that is most intense with the first few steps in the morning or after periods of rest
- Pain that improves slightly with activity but worsens after prolonged standing or weight-bearing
- Tenderness at the bottom of the heel, particularly at the medial calcaneal tubercle where the plantar fascia attaches to the heel bone
- Pain that radiates along the arch of the foot
- Stiffness in the foot
- Associated heel swelling or redness, though this is less common
Risk Factors
- Excessive pronation (flat feet)
- High arches
- Tight Achilles tendons
- Obesity
- Activities that place repetitive stress on the heel
Diagnosis
- Radiography is the initial imaging study of choice, as it is useful to distinguish among different causes of chronic foot pain and has a sensitivity of 85% and a specificity of 95% for plantar fasciitis 1
- Ultrasound (US) may be performed when there is a high clinical suspicion of pathologic conditions of the Achilles tendon, plantar fascia, and other conditions such as tarsal tunnel syndrome, Morton’s neuroma, plantar plate tears, and intermetatarsal bursitis
Treatment
- Initial treatment measures include rest, ice, and physical therapy, and if no improvement occurs after six weeks, referral to a podiatric foot and ankle surgeon is appropriate 1
- Additional treatments may include a customized orthotic device, night splinting, a limited number of corticosteroid injections, casting, or use of a fixed-ankle walker-type device during activity
- If no improvement occurs after two to three months, initial treatment measures are continued, and further options include surgery (plantar fasciotomy) and extracorporeal shock wave therapy 1
From the Research
Plantar Fasciitis Symptoms
- Heel pain is a common symptom of plantar fasciitis, affecting more than 1 million persons per year 2
- Patients may present with heel pain with their first steps in the morning or after prolonged sitting, and sharp pain with palpation of the medial plantar calcaneal region 2
- Discomfort in the proximal plantar fascia can be elicited by passive ankle/first toe dorsiflexion 2
- Pain and tenderness, predominately on the medial aspect of the calcaneus near the sole of the heel, are characteristic features of plantar fasciitis 3
Risk Factors
- Obesity, excessive foot pronation, excessive running, and prolonged standing are risk factors for developing plantar fasciitis 2
- Biomechanical abnormalities in the foot, such as tight Achilles tendon, pes cavus, and pes planus, have been associated with plantar fasciitis 4
- Middle age has also been associated with plantar fasciitis 4
Diagnosis
- Diagnosis is primarily based on history and physical examination 2
- Diagnostic imaging, such as ultrasonography and magnetic resonance imaging, is rarely needed for the initial diagnosis of plantar fasciitis, but can be used to confirm the diagnosis or rule out other heel pathology 2
- A comprehensive history and physical examination guide accurate diagnosis, and considering a complete differential diagnosis of plantar heel pain is important 3
Treatment
- Conservative treatments, such as rest, activity modification, ice massage, oral analgesics, and stretching techniques, can help with the disabling pain 2
- Physician-prescribed treatments, such as physical therapy modalities, foot orthotics, night splinting, and corticosteroid injections, can be considered if heel pain persists 2
- Local injection of platelet-rich plasma or corticosteroid is an effective treatment option for chronic plantar fasciitis 5
- Nonsurgical management of plantar fasciitis is successful in approximately 90% of patients 2, 4, 3