Foot and Ankle Conditions: Plantar Fasciitis

Plantar fasciitis is the most common cause of heel pain in adults. It involves painful symptoms occurring along the plantar fascia with or without the presence of a bony heel spur. Heel pain that occurs on standing after a prolonged non-weight-bearing period is a prominent symptom of plantar fasciitis. On physical examination, palpation along the medial plantar calcaneal region reproduces the painful symptoms. Routine imaging studies usually are not necessary but can be used to rule out pathologies or confirm chronic or recalcitrant plantar fasciitis. The presence of a heel spur on x-ray is not thought to be an underlying cause of symptoms and indicates the condition has been present for at least 6 to 12 months. Conservative therapies such as rest, ice massage, nonsteroidal anti-inflammatory drugs, specific plantar fascia stretching exercises, and orthoses are the preferred initial treatments. Injection therapies using a corticosteroid or platelet-rich plasma typically provide short-term relief. If conservative treatment is ineffective, extracorporeal shock wave therapy and surgery may be considered.