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Plantar fasciitis

Last reviewed: 3 Apr 2025
Last updated: 04 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • heel pain (stabbing or knife-like)
  • pain relieved with rest
  • poststatic dyskinesia
  • pain exacerbated by standing and other activities of daily living
Full details

Other diagnostic factors

  • pain exacerbated by walking barefoot or in nonsupportive footwear
  • pain improved with nonsteroidal anti-inflammatory drug (NSAID) use
  • no history of acute injury to the heel
  • self-limiting pain
  • unilateral heel pain
  • positive dorsiflexion-eversion test
  • positive Windlass test
  • negative Tinel sign
Full details

Risk factors

  • Increased body mass index (BMI)
  • equinus
  • pes planus
  • pes cavus
  • age >40 years old
  • history of prolonged standing or walking
  • athletes, particularly runners
  • sedentary lifestyle
  • wearing improper or excessively worn shoes
  • increases or changes in activity
Full details

Diagnostic tests

1st tests to order

  • foot x-ray
Full details

Tests to consider

  • technetium (Tc-MDP 3-phase) bone scan
  • MRI
  • HLA-B27
  • rheumatoid factor
  • ultrasound
Full details

Treatment algorithm

ONGOING

all patients

Contributors

Authors

Martha Anderson, DPM, FACFAS
Martha Anderson

Podiatric Foot and Ankle Surgeon

Private Practice

Foot and Ankle Wellness Center

Podiatric Foot and Ankle Surgeon

Department of Surgery

Grady Memorial Hospital

Delaware

OH

Disclosures

MA declares that she has no competing interests.

Acknowledgements

Dr Martha Anderson would like to gratefully acknowledge Dr Georgeanne Botek, the previous contributor to this topic. GB declares that she has no competing interests.

Peer reviewers

Mark A. Hardy, DPM, FACFAS

Director

Foot and Ankle Trauma Service

Kaiser Permanente

Cleveland

OH

Disclosures

MAH declares that he has no competing interests.

Molly Judge, DPM, FACFAS

Board Certified in Reconstructive Rear foot and Ankle Surgery

Department of Surgery

St. Vincent Charity Hospital

Cleveland

OH

Disclosures

MJ declares that she has no competing interests.

Patrick J. McKee, DPM

Program Director

Podiatric Residency

Cleveland Clinic

Cleveland

OH

Disclosures

PJM declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Schneider HP, Baca JM, Carpenter BB, et al. American College of Foot and Ankle Surgeons clinical consensus statement: diagnosis and treatment of adult acquired infracalcaneal heel pain. J Foot Ankle Surg. 2018 Mar-Apr;57(2):370-81.Full text  Abstract

Rhim HC, Kwon J, Park J, et al. A systematic review of systematic reviews on the epidemiology, evaluation, and treatment of plantar fasciitis. Life (Basel). 2021 Nov 24;11(12).Full text  Abstract

Koc TA Jr, Bise CG, Neville C, et al. Heel pain - plantar fasciitis: revision 2023. J Orthop Sports Phys Ther. 2023 Dec;53(12):CPG1-39.Full text  Abstract

American College of Radiology. ACR appropriateness criteria: chronic foot pain​. 2020 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Plantar fasciitis images
  • Differentials

    • Plantar fascia rupture
    • Heel fat pad syndrome (fat pad atrophy)
    • Proximal plantar fibromatosis (Ledderhose disease)
    More Differentials
  • Guidelines

    • Heel pain - plantar fasciitis: revision 2023
    • ACR appropriateness criteria: chronic foot pain​
    More Guidelines
  • Patient information

    Heel pain (plantar fasciitis)

    Obesity - drugs and surgery

    More Patient information
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