CKS identified no guidelines or reviews that gave comprehensive advice on referral; referral recommendations are therefore based on what CKS considers to be good clinical practice.

• Referral to a podiatrist or physiotherapist is recommended after about 3 months if initial advice and treatment is ineffective; this is in line with a UK guideline which recommends referral after 3–6 months of non-response [ARC, 2004a].
• A podiatrist can give expert advice on exercise and prescribe custom-made orthoses, although evidence from randomized controlled trials that these are superior to prefabricated orthoses is lacking.
• Other conservative options that may be available in a secondary care environment (e.g. physiotherapy) include taping, night splints, and manual therapy, but overall trial evidence for these is lacking or absent.
• If the diagnosis is uncertain, referral to a podiatrist or orthopaedic surgeon for further investigation (depending on the suspicion of the cause) is necessary.
• If the pain persists and affects quality of life after maximal treatment in primary care (i.e. several injections of corticosteroid have been tried), referral to an orthopaedic or podiatric surgeon may be considered.
• One electronic guideline suggests this should be 6–9 months after the last course of treatment, although this is probably based on opinion rather than evidence [Foye and Stitik, 2008].
• A surgeon may attempt fascia release, although there is no evidence available on the benefits and harms of this [ARC, 2004a].