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Plantar Fasciitis

Plantar fasciitis (or plantar fasciopathy) is a common condition among the general public. It accounts for around 1 million patient visits per year, effects 1 in 10 people throughout their lifetime, and has an increased incidence in women 40-60 years of age. It also typically occurs in both recreational and elite runners. Some factors that might predispose an individual to develop plantar fasciitis include limited ankle mobility, body mass index >27 (overweight), and spending most of the workday on one's feet.

Typical signs and symptoms of plantar fasciitis include sharp pain and tenderness at the front edge of the bottom of the heel (see picture below). The pain is typically felt upon taking the first few steps out of bed in the morning and will gradually resolve as activity progresses. The pain will also tend to "flare up" again at the end of the day. Diagnosis of plantar fasciitis is made after a detailed physical examination conducted by a healthcare professional. Imaging studies such as x-ray, MRI, and diagnostic ultrasound are usually reserved for cases that are unresponsive to initial treatment or for those cases where the clinician suspects some other condition as the causative factor of the patient's heel pain. These conditions include stress fractures, bone tumors, certain types of arthritis, and complete plantar fascia rupture/tear, among others.

So what is the prognosis and management for plantar fasciitis? Luckily, around 80% of patients improve within 12 months after undergoing nonoperative therapy. These non-operative therapies include stretching/strengthening, foot orthoses, taping, dry needling/acupuncture, nighttime splints, extracorporeal shock wave therapy, and several different types of injections.

Stretching and strengthening are both essential to recovery, and strengthening appears to have the largest effect on long-term recovery. Orthotic therapy also appears to be effective in managing plantar fascia pain. In fact, using "off-the-shelf" orthotics was equally effective when compared to expensive, customized orthotics. Taping for arch support may also reduce pain in the short-term (first week of symptoms) but effectiveness tends to fade over time. Dry needling/acupuncture lacks an abundance of high-quality evidence supporting its use but there are some studies which demonstrate reduction in heel pain. The American College of Foot and Ankle Surgeons does not recommend for or against the use of dry needling/acupuncture for plantar fasciitis. Similarly, night splints have limited evidence supporting their use but may help certain individuals in certain situations. Lastly, extracorporeal shock wave therapy (ESWT) and injections (i.e. corticosteroids, platelet-rich-plasma, botulinum toxin) should be reserved for cases where traditional conservative therapy has failed. Both ESWT and injections can be beneficial for some patients, but again, the evidence is lacking and needs more investigation.

Surgical intervention for plantar fasciitis should only be considered when nonoperative treatments have failed. Full recovery from this surgery typically takes 3 months or more.

Plantar fasciitis/plantar fasciopathy can be a significant source of distress for sufferers. It often results in decreased physical activity, which paradoxically, is the one thing that all plantar fasciitis patients need in order to recover fully. This is why the condition tends to become a chronic condition that can last months/years. But this doesn't have to be the case! Know there are clinicians out there that can guide you through the maze that is navigating plantar fasciitis.

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