Most commonly affects people between 40 and 60 years of age who are overweight or obese. Also occurs in 10% of runners.
Diagnosis is usually based on a thorough history and physical examination. There is no laboratory test that can confirm or rule out the diagnosis.
Plain film x-rays are of little benefit in typical cases, although they may be helpful in ruling out other pathology.
Infracalcaneal spurring is found in only 39% to 50% of cases.
Nonsurgical treatment is the standard of care for acute heel pain, although 10% of cases are recalcitrant and unresponsive to nonsurgical care in 12 months. In recalcitrant cases, surgery has been shown to be generally effective.
Conservative treatment involves combination therapy (e.g., heel padding, shoe changes, low-Dye strapping, nonsteroidal anti-inflammatory drugs, and stretching exercises).
Plantar fasciitis is an acute or chronic pain in the inferior heel at the attachment of the medial band of the plantar fascia to the medial calcaneal tubercle. It has been described as a chronic inflammatory process and may be an overuse injury. Pain is worst when taking the first few steps out of bed in the morning and after periods of rest. Although an aggravating condition, pain is self-limiting and usually resolves between 6 to 18 months without treatment.
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
- pes planus
- pes cavus
- age >40 years old
- history of prolonged standing
1st investigations to order
- foot x-ray
Investigations to consider
- technetium (Tc-MDP 3-phase) bone scan
- rheumatoid factor
- Plantar fascia rupture
- Inferior calcaneal bursitis
- Calcaneal contusion
- ACR appropriateness criteria: chronic foot pain
- Heel pain: plantar fasciitis
Heel pain (plantar fasciitis)
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