CHARLES COLE, M.D., CRAIG SETO, M.D., and JOHN GAZEWOOD, M.D., M.S.P.H. University of Virginia School of Medicine, Charlottesville, Virginia
Plantar fasciitis causes heel pain in active as well as sedentary adults of all ages. The condition is more likely to occur in persons who are obese or in those who are on their feet most of the day. A diagnosis of plantar fasciitis is based on the patient's history and physical findings. The accuracy of radiologic studies in diagnosing plantar heel pain is unknown. Most interventions used to manage plantar fasciitis have not been studied adequately; however, shoe inserts, stretching exercises, steroid injection, and custom-made night splints may be beneficial. Extracorporeal shock wave therapy may effectively treat runners with chronic heel pain but is ineffective in other patients. Limited evidence suggests that casting or surgery may be beneficial when conservative measures fail. Plantar fasciitis commonly causes inferior heel pain and occurs in up to 10 percent of the U.S. population. Plantar fasciitis accounts for more than 600,000 outpatient visits annually in the United States.1 The condition affects active and sedentary adults of all ages. Plantar fasciitis is more likely to occur in persons who are obese, who spend most of the day on their feet, or who have limited ankle flexion.2 Experts believe that the pain is caused by acute or chronic injury to the origin of the plantar fascia from cumulative overload stress. Diagnosis Diagnosis of plantar fasciitis is based on the patient's history and on results of the physical examination. Patients typically present with inferior heel pain on weight bearing, and the pain often persists for months or even years. Pain associated with plantar fasciitis may be throbbing, searing, or piercing, especially with the first few steps in the morning or after periods of inactivity. The discomfort often improves after further ambulation but worsens with continued activity, often limiting daily activities. Walking barefoot, on toes, or up stairs may exacerbate the pain.3 The patient usually has tenderness around the medial calcaneal tuberosity at the plantar aponeurosis. A number of other conditions cause heel pain; most of these can be distinguished from plantar fasciitis by a history and physical examination.
Am Fam Physician 2005;72:2237-42, 2247-8. Copyright © 2005 American Academy of Family Physicians.
