Summary
Definition
History and exam
Key diagnostic factors
- heel pain (stabbing or knife-like)
- pain relieved with rest
- poststatic dyskinesia
Other diagnostic factors
- pain exacerbated by walking barefoot
- 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
Risk factors
- obesity
- equinus
- pes planus
- pes cavus
- age >40 years old
- history of prolonged standing
- runners
Diagnostic investigations
1st investigations to order
- foot x-ray
Investigations to consider
- technetium (Tc-MDP 3-phase) bone scan
- MRI
- HLA-B27
- rheumatoid factor
Emerging tests
- ultrasound
Treatment algorithm
all patients
Contributors
Authors
Martha Anderson, DPM, FACFAS

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.
Differentials
- Plantar fascia rupture
- Inferior calcaneal bursitis
- Calcaneal contusion
More DifferentialsGuidelines
- ACR appropriateness criteria: chronic foot pain
- Heel pain: plantar fasciitis
More GuidelinesPatient leaflets
Heel pain (plantar fasciitis)
Obesity - drugs and surgery
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