Plantar fasciitis
Plantar fasciitis is a clinical diagnosis made from sharp medial-inferior heel pain worst with the first morning steps and a tender medial calcaneal tubercle, treated first with stretching, footwear correction, and NSAIDs before escalating to injection.
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What this article covers
- Overview
Plantar fasciitis is degeneration and microtearing of the plantar fascia at its origin on the medial calcaneal tuberosity, producing the most common cause of heel pain seen in general and sports medicine practice.
- Epidemiology
The most common cause of heel pain in adults: plantar fasciitis accounts for the large majority of self-limited hindfoot pain presentations in primary care and sports medicine.
- Risk factors
Obesity: the leading modifiable risk factor, from increased mechanical load transmitted through the plantar fascia with each step.
- Pathophysiology
Chronic microtear and degeneration, not pure inflammation: repetitive mechanical overuse or stress on the plantar fascia produces microtears and recurrent low-grade inflammation at its origin on the…
- Clinical features
Sharp, medial-inferior heel pain worst with the first steps of the morning or after any period of inactivity, improving somewhat with continued walking but potentially persisting through the day in…
- Differential diagnosis
Calcaneal stress fracture: diffuse bony heel tenderness with pain reproduced by percussion or by hopping on the affected leg, rather than the focal soft-tissue tenderness of fasciitis; more likely…
- Diagnosis
Plantar fasciitis is a clinical diagnosis established by the combination of first-step morning heel pain and focal tenderness at the medial calcaneal tubercle; no formal numeric criteria set exists…
- Management
First, start conservative measures for every patient: calf and plantar fascia stretching exercises, ice after activity, weight loss when applicable, and replacing unsupportive footwear with…
- Complications
Chronic or refractory pain: the most common complication, when the condition persists beyond the expected months-long course despite conservative therapy.
- Prognosis
Generally self-limited but slow to resolve: resolution can take many months even with adherent stretching and conservative care.
- Prevention
Weight management: reducing obesity, the leading modifiable risk factor, lowers plantar fascia loading with every step.
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