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Plantar fasciitis - Management
Basis for recommendation
These recommendations are based on an American evidence-based guideline [McPoil et al, 2008], a UK guideline [ARC, 2004a], an electronic guideline [Foye and Stitik, 2008], and a narrative review [Neufeld, 2008].
- A systematic review (search date: August 2005) identified increased weight (in a non-athletic population), increased age, and prolonged standing, as risk factors associated with plantar fasciitis [Irving et al, 2006].
- A positive clinical history and examination will successfully diagnose most cases of plantar fasciitis; plantar fasciitis accounts for 80% of cases of heel pain, and symptoms and signs taken together are sensitive and specific.
- First-step heel pain on waking is very common, as the plantar fascia contracts during rest and sleep, leading to stiffness and pain upon subsequent weight-bearing.
- The Windlass test is highly specific for plantar fasciitis, but not very sensitive, making it a suitable tool for confirming diagnoses rather than for screening.
- Investigations are generally not useful for diagnosing plantar fasciitis (such as the presence of a calcaneal spur is not now believed to be a key radiographic feature of plantar fasciitis) [ARC, 2004a].
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