Editing Plantar fasciitis

{{short description|Connective tissue disorder of the heel}}
{{good article}}
{{Infobox medical condition (new)
| name          = Plantar fasciitis
| image         = PF-PainAreas.jpg
| caption       = Most common areas of pain in plantar fasciitis
| field         = [[Orthopedics]], [[sports medicine]], [[plastic surgery]], [[podiatry]]
| synonyms      = Plantar fasciosis, plantar fasciopathy, jogger's heel, heel spur syndrome<ref name="Toronto_2017"/>
| symptoms      = [[Pain]] in the [[heel]] and [[Sole (foot)|bottom of the foot]]<ref name="Bee_2014"/>
| complications = 
| onset         = Gradual<ref name="Rosenbaum_2014"/>
| duration      = 
| causes        = Unclear<ref name="Bee_2014"/>
| risks         = Overuse (long periods of standing), [[obesity]], [[Pronation of the foot|inward rolling of the foot]]<ref name="Bee_2014"/><ref name="Goff_2011"/>
| diagnosis     = Based on symptoms, [[ultrasound]]<ref name="Bee_2014"/>
| differential  = [[Osteoarthritis]], [[ankylosing spondylitis]], [[heel pad syndrome]], [[reactive arthritis]]<ref name="Cutts_2012"/><ref name="Tu_2011"/>
| prevention    = 
| treatment     = [[Conservative management]]<ref name="Goff_2011"/><ref name="Tahririan_2012"/>
| medication    = 
| prognosis     = 
| frequency     = ~4%<ref name="Bee_2014"/><ref name="Cutts_2012"/>
| deaths        = 
}}

<!-- Definition and symptoms -->
'''Plantar fasciitis''' or '''plantar heel pain''' is a disorder of the [[plantar fascia]], which is the [[connective tissue]] that supports the [[Arches of the foot|arch of the foot]].<ref name="Bee_2014"/> It results in pain in the [[heel]] and [[Sole (foot)|bottom of the foot]] that is usually most severe with the first steps of the day or following a period of rest.<ref name="Bee_2014"/><ref name="Goff_2011"/> Pain is also frequently brought on by [[dorsiflexion|bending the foot and toes up towards the shin]].<ref name="Rosenbaum_2014"/><ref name="Goff_2011">{{cite journal | vauthors = Goff JD, Crawford R | title = Diagnosis and treatment of plantar fasciitis | journal = American Family Physician | volume = 84 | issue = 6 | pages = 676–682 | date = September 2011 | pmid = 21916393 | url = https://www.aafp.org/afp/2011/0915/p676.html }}</ref> The pain typically comes on gradually, and it affects both feet in about one-third of cases.<ref name="Bee_2014"/><ref name="Rosenbaum_2014"/>

<!-- Risk factors, mechanism, and diagnosis -->
The cause of plantar fasciitis is not entirely clear.<ref name="Bee_2014"/> Risk factors include overuse, such as from long periods of standing, an increase in exercise, and [[obesity]].<ref name="Bee_2014"/><ref name="Goff_2011"/> It is also associated with [[pronation of the foot|inward rolling of the foot]], a tight [[Achilles tendon]], and a sedentary lifestyle.<ref name="Bee_2014"/><ref name="Goff_2011"/> It is unclear if [[calcaneal spur|heel spurs]] have a role in causing plantar fasciitis even though they are commonly present in people who have the condition.<ref name="Bee_2014"/> Plantar fasciitis is a disorder of the insertion site of the ligament on the bone characterized by micro tears, breakdown of collagen, and scarring.<ref name="Bee_2014"/> Since [[inflammation]] plays either a lesser or no role, a review proposed it be renamed '''plantar fasciosis'''.<ref name="Bee_2014">{{cite journal | vauthors = Beeson P | title = Plantar fasciopathy: revisiting the risk factors | journal = Foot and Ankle Surgery | volume = 20 | issue = 3 | pages = 160–165 | date = September 2014 | pmid = 25103701 | doi = 10.1016/j.fas.2014.03.003 | url = http://nectar.northampton.ac.uk/6575/1/Beeson20146575.pdf }}</ref><ref name="Lareau_2014">{{cite journal | vauthors = Lareau CR, Sawyer GA, Wang JH, DiGiovanni CW | title = Plantar and medial heel pain: diagnosis and management | journal = The Journal of the American Academy of Orthopaedic Surgeons | volume = 22 | issue = 6 | pages = 372–380 | date = June 2014 | pmid = 24860133 | doi = 10.5435/JAAOS-22-06-372 | s2cid = 43241954 }}</ref> The presentation of the symptoms is generally the basis for diagnosis; with [[ultrasound]] sometimes being useful if there is uncertainty.<ref name="Bee_2014"/> Other conditions with similar symptoms include [[osteoarthritis]], [[ankylosing spondylitis]], [[heel pad syndrome]], and [[reactive arthritis]].<ref name="Cutts_2012"/><ref name="Tu_2011">{{cite journal | vauthors = Tu P, Bytomski JR | title = Diagnosis of heel pain | journal = American Family Physician | volume = 84 | issue = 8 | pages = 909–916 | date = October 2011 | pmid = 22010770 | url = https://www.aafp.org/afp/2011/1015/p909.html }}</ref>

<!-- Prevention and treatment -->
Most cases of plantar fasciitis resolve with time and conservative methods of treatment.<ref name="Goff_2011"/><ref name="Tahririan_2012">{{cite journal | vauthors = Tahririan MA, Motififard M, Tahmasebi MN, Siavashi B | title = Plantar fasciitis | journal = Journal of Research in Medical Sciences | volume = 17 | issue = 8 | pages = 799–804 | date = August 2012 | pmid = 23798950 | pmc = 3687890 }}</ref> For the first few weeks, those affected are usually advised to rest, change their activities, take [[analgesics|pain medications]], and stretch.<ref name="Goff_2011"/> If this is not sufficient, [[physiotherapy]], [[orthotics]], [[Splint (medicine)|splinting]], or [[corticosteroid|steroid injections]] may be options.<ref name="Goff_2011"/> If these measures are not effective, additional measures may include [[extracorporeal shockwave therapy]] or surgery.<ref name="Goff_2011"/>

<!-- Epidemiology -->
Between 4% and 7% of the general population has heel pain at any given time: about 80% of these are due to plantar fasciitis.<ref name="Bee_2014"/><ref name="Cutts_2012">{{cite journal | vauthors = Cutts S, Obi N, Pasapula C, Chan W | title = Plantar fasciitis | journal = Annals of the Royal College of Surgeons of England | volume = 94 | issue = 8 | pages = 539–542 | date = November 2012 | pmid = 23131221 | pmc = 3954277 | doi = 10.1308/003588412X13171221592456 }}</ref> Approximately 10% of people have the disorder at some point during their life.<ref name="Zhiyun_2013">{{cite journal | vauthors = Zhiyun L, Tao J, Zengwu S | title = Meta-analysis of high-energy extracorporeal shock wave therapy in recalcitrant plantar fasciitis | journal = [[Swiss Medical Weekly]] | volume = 143 | pages = w13825 | date = July 2013 | pmid = 23832373 | doi = 10.4414/smw.2013.13825 | doi-access = free }}</ref> It becomes more common with age.<ref name="Bee_2014"/> It is unclear if one sex is more affected than the other.<ref name="Bee_2014"/>

==Signs and symptoms==
When plantar fasciitis occurs, the pain is typically sharp<ref name="Jeswani_2009">{{cite journal | vauthors = Jeswani T, Morlese J, McNally EG | title = Getting to the heel of the problem: plantar fascia lesions | journal = Clinical Radiology | volume = 64 | issue = 9 | pages = 931–939 | date = September 2009 | pmid = 19664484 | doi = 10.1016/j.crad.2009.02.020 }}</ref> and usually unilateral (70% of cases).<ref name="Tahririan_2012"/> Bearing weight on the heel after long periods of rest worsens heel pain in affected individuals.<ref name="Molloy_2012"/> Individuals with plantar fasciitis often report their symptoms are most intense during their first steps after getting out of bed or after prolonged periods of sitting.<ref name="Goff_2011"/> Symptoms typically improve with continued walking.<ref name="Goff_2011"/><ref name="Tu_2011"/><ref name="Jeswani_2009"/>  Rare, but reported, symptoms include [[Hypoesthesia|numbness]], [[paresthesia|tingling]], [[Edema|swelling]], and radiating pain.<ref name="Monto_2013"/> Typically there are no [[fever]]s or night sweats.<ref name="Rosenbaum_2014">{{cite journal | vauthors = Rosenbaum AJ, DiPreta JA, Misener D | title = Plantar heel pain | journal = The Medical Clinics of North America | volume = 98 | issue = 2 | pages = 339–352 | date = March 2014 | pmid = 24559879 | doi = 10.1016/j.mcna.2013.10.009 }}</ref>

If the [[plantar fascia]] is overused in the setting of plantar fasciitis, the plantar fascia can rupture. Typical signs and symptoms of plantar fascia rupture include a clicking or snapping sound, significant local swelling, and acute pain in the bottom of the foot.<ref name="Jeswani_2009"/>

==Risk factors==
Identified risk factors for plantar fasciitis include excessive running, standing on hard surfaces for prolonged periods, [[Pes cavus|high arches of the feet]], the presence of a [[leg length inequality]], and [[Pes planus|flat feet]]. The tendency of flat feet to excessively [[pronation of the foot|roll inward]] during walking or running makes them more susceptible to plantar fasciitis.<ref name="Goff_2011"/><ref name="Molloy_2012"/><ref name="Orchard_2012"/> [[Obesity]] is seen in 70% of individuals who present with plantar fasciitis and is an independent risk factor.<ref name="Rosenbaum_2014"/>

Plantar fasciitis is commonly a result of some biomechanical imbalance that causes an increased amount of tension placed along the plantar fascia.<ref>{{cite journal | vauthors = Barrett SJ, O'Malley R | title = Plantar fasciitis and other causes of heel pain | journal = American Family Physician | volume = 59 | issue = 8 | pages = 2200–2206 | date = April 1999 | pmid = 10221305 | url = https://www.aafp.org/afp/1999/0415/p2200.html }}</ref>

[[Achilles tendon]] tightness and inappropriate footwear have also been identified as significant risk factors.<ref name="Yin_2014"/><ref name="Freakonomics">{{cite web | vauthors = Dubner S |title=These Shoes Are Killing Me! |url=https://freakonomics.com/podcast/shoes/ |website=Freakonomics |access-date=12 June 2020}}</ref>

==Pathophysiology==
[[File:PF-PlantarDesignCrop.jpg|thumb|Drawing of the plantar fascia]]
The cause of plantar fasciitis is poorly understood and appears to have several contributing factors.<ref name="Yin_2014"/> The plantar fascia is a [[Aponeurosis|thick fibrous band of connective tissue]] that originates from the [[Tubercle (anatomy)|medial tubercle]] and anterior aspect of the [[calcaneus|heel bone]]. From there, the fascia extends along the [[Sole (foot)|sole of the foot]] before inserting at the base of the [[toe]]s and supports the [[Arches of the foot|arch of the foot]].<ref name="Rosenbaum_2014"/><ref name="Molloy_2012">{{cite journal | vauthors = Molloy LA | title = Managing chronic plantar fasciitis: when conservative strategies fail | journal = JAAPA | volume = 25 | issue = 11 | pages = 48, 50, 52-48, 50, 53 | date = November 2012 | pmid = 23620924 | doi = 10.1097/01720610-201211000-00009 | s2cid = 36296481 }}</ref><ref name="Orchard_2012">{{cite journal | vauthors = Orchard J | title = Plantar fasciitis | journal = BMJ | volume = 345 | issue = oct10 1 | pages = e6603 | date = October 2012 | pmid = 23054045 | doi = 10.1136/bmj.e6603 | s2cid = 27948691 }}</ref>

Plantar fasciitis is a non-inflammatory condition of the plantar fascia. Within the last decade, studies have observed [[Histology|microscopic anatomical]] changes indicating that plantar fasciitis is due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process.<ref name="Tahririan_2012"/><ref name="Yin_2014"/>

Many in the academic community have stated the condition should be renamed plantar fasciosis in light of these newer findings.<ref name="Tu_2011"/> Repetitive [[microtrauma]] (small tears) appears to cause a structural breakdown of the plantar fascia.<ref name="Monto_2013"/><ref name="Orchard_2012"/> Microscopic examination of the plantar fascia often shows [[myxomatous degeneration]], connective tissue [[calcification|calcium deposits]], and disorganized collagen fibers.<ref name="Lareau_2014"/>

Disruptions in the plantar fascia's normal mechanical movement during standing and walking (known as the Windlass mechanism) place excess strain on the [[calcaneal tuberosity]] and seem to contribute to the development of plantar fasciitis.<ref name="Yin_2014"/> Other studies have also suggested that plantar fasciitis is not due to the inflamed plantar fascia but maybe a [[tendinopathy|tendon injury]] involving the [[flexor digitorum brevis muscle]] located immediately deep to the plantar fascia.<ref name="Orchard_2012"/>

==Diagnosis==
[[File:Dorsiplantar.jpg|thumb|upright|[[Achilles tendon]] tightness is a risk factor for plantar fasciitis. It can lead to decreased [[dorsiflexion]] of the foot.]]
[[File:Projectional radiography of calcaneal spur.jpg|thumb|[[Calcaneus|Heel bone]] with heel spur (red arrow)]]
[[File:Plantarfascia.png|thumb|Thickened plantar fascia in ultrasound]]

Plantar fasciitis is usually diagnosed by a [[health care provider]] after consideration of a person's presenting history, risk factors, and clinical examination.<ref name="Goff_2011"/><ref name="Buchbinder_2014">{{cite journal | vauthors = Buchbinder R | title = Clinical practice. Plantar fasciitis | journal = The New England Journal of Medicine | volume = 350 | issue = 21 | pages = 2159–2166 | date = May 2004 | pmid = 15152061 | doi = 10.1056/NEJMcp032745 }}</ref><ref>{{cite journal | vauthors = Cole C, Seto C, Gazewood J | title = Plantar fasciitis: evidence-based review of diagnosis and therapy | journal = American Family Physician | volume = 72 | issue = 11 | pages = 2237–2242 | date = December 2005 | pmid = 16342847 | url = https://www.aafp.org/afp/2005/1201/p2237.html }}</ref> Palpation along the inner aspect of the heel bone on the sole may elicit tenderness during the physical examination.<ref name="Goff_2011"/><ref name="Molloy_2012"/> The foot may have limited [[dorsiflexion]] due to excessive tightness of the [[Triceps surae muscle|calf muscles]] or the [[Achilles tendon]].<ref name="Tahririan_2012"/> Dorsiflexion of the foot may elicit the pain due to stretching of the plantar fascia with this motion.<ref name="Goff_2011"/><ref name="Monto_2013"/> Diagnostic imaging studies are not usually needed to diagnose plantar fasciitis.<ref name="Tahririan_2012"/> Occasionally, a physician may decide imaging studies (such as [[Radiography|X-rays]], [[Medical ultrasonography|diagnostic ultrasound]], or [[Magnetic resonance imaging|MRI]]) are warranted to rule out serious causes of foot pain.

Other diagnoses that are typically considered include fractures, tumors, or systemic disease if plantar fasciitis pain fails to respond appropriately to conservative medical treatments.<ref name="Goff_2011"/><ref name="Molloy_2012"/> Bilateral heel pain or heel pain in the context of a systemic illness may indicate a need for a more in-depth diagnostic investigation. Under these circumstances, diagnostic tests such as a [[complete blood count|CBC]] or serological markers of inflammation, infection, or [[autoimmune disease]] such as [[C-reactive protein]], [[erythrocyte sedimentation rate]], [[anti-nuclear antibody|anti-nuclear antibodies]], [[rheumatoid factor]], [[HLA-B27]], [[uric acid]], or [[Lyme disease]] antibodies may also be obtained.<ref name="Cutts_2012"/> Neurological deficits may prompt an investigation with [[electromyography]] to check for damage to the nerves or muscles.<ref name="Monto_2013"/>

An incidental finding associated with this condition is a [[heel spur]], a small bony [[calcification]] on the [[calcaneus]] (heel bone), which can be found in up to 50% of those with plantar fasciitis.<ref name="Tu_2011"/> In such cases, it is the underlying plantar fasciitis that produces the heel pain, and not the spur itself.<ref name="Orchard_2012"/> The condition is responsible for the creation of the spur though the clinical significance of heel spurs in plantar fasciitis remains unclear.<ref name="Monto_2013"/>

===Imaging===
Medical imaging is not routinely needed. It is expensive and does not typically change how plantar fasciitis is managed.<ref name="Yin_2014">{{cite journal | vauthors = Yin MC, Ye J, Yao M, Cui XJ, Xia Y, Shen QX, Tong ZY, Wu XQ, Ma JM, Mo W | display-authors = 6 | title = Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials | journal = Archives of Physical Medicine and Rehabilitation | volume = 95 | issue = 8 | pages = 1585–1593 | date = August 2014 | pmid = 24662810 | doi = 10.1016/j.apmr.2014.01.033 }}</ref> When the diagnosis is not clinically apparent, lateral view X-rays of the ankle are the recommended imaging modality to assess for other causes of heel pain, such as [[stress fracture]]s or bone spur development.<ref name="Tahririan_2012"/>

The plantar fascia has three fascicles-the central fascicle being the thickest at 4&nbsp;mm, the [[lateral (anatomy)|lateral]] fascicle at 2&nbsp;mm, and the [[medial (anatomy)|medial]] less than a millimeter thick.<ref>{{cite journal | vauthors = Ehrmann C, Maier M, Mengiardi B, Pfirrmann CW, Sutter R | title = Calcaneal attachment of the plantar fascia: MR findings in asymptomatic volunteers | journal = Radiology | volume = 272 | issue = 3 | pages = 807–814 | date = September 2014 | pmid = 24814176 | doi = 10.1148/radiol.14131410 }}</ref> In theory, plantar fasciitis becomes more likely as the plantar fascia's thickness at the calcaneal insertion increases. A thickness of more than 4.5&nbsp;mm [[ultrasound]] and 4&nbsp;mm on [[magnetic resonance imaging|MRI]] are useful for diagnosis.<ref>{{cite journal | vauthors = League AC | title = Current concepts review: plantar fasciitis | journal = Foot & Ankle International | volume = 29 | issue = 3 | pages = 358–366 | date = March 2008 | pmid = 18348838 | doi = 10.3113/fai.2008.0358 | s2cid = 6734497 }}</ref> Other imaging findings, such as thickening of the plantar aponeurosis, are nonspecific and have limited usefulness in diagnosing plantar fasciitis.<ref name="Orchard_2012"/>

[[Bone scan|Three-phase bone scan]] is a sensitive modality to detect active plantar fasciitis. Furthermore, a [[bone scan|3-phase bone scan]] can be used to monitor response to therapy, as demonstrated by decreased uptake after corticosteroid injections.<ref>{{cite journal | vauthors = Pelletier-Galarneau M, Martineau P, Gaudreault M, Pham X | title = Review of running injuries of the foot and ankle: clinical presentation and SPECT-CT imaging patterns | journal = American Journal of Nuclear Medicine and Molecular Imaging | volume = 5 | issue = 4 | pages = 305–316 | year = 2015 | pmid = 26269770 | pmc = 4529586 }}</ref>

===Differential diagnosis===
The differential diagnosis for heel pain is extensive and includes pathological entities including, but not limited to, the following: [[calcaneal fracture|calcaneal stress fracture]], [[septic arthritis]], [[Policeman's heel|calcaneal bursitis]], [[osteoarthritis]], [[spinal stenosis]] involving the nerve roots of [[lumbar spinal nerve 5|lumbar spinal nerve 5 (L5)]] or [[sacral spinal nerve 1|sacral spinal nerve 1 (S1)]], calcaneal fat pad syndrome, metastasized cancers from elsewhere in the body, [[hypothyroidism]], [[gout]], [[Seronegative spondyloarthropathy|seronegative spondyloparthopathies]] such as [[reactive arthritis]], [[ankylosing spondylitis]], or [[rheumatoid arthritis]] (more likely if pain is present in both heels),<ref name="Cutts_2012"/> plantar fascia rupture, and [[compression neuropathy|compression neuropathies]] such as [[tarsal tunnel syndrome]] or impingement of the [[Medial calcaneal branches of the tibial nerve|medial calcaneal nerve]].<ref name="Rosenbaum_2014"/><ref name="Cutts_2012"/><ref name="Tahririan_2012"/>

A determination about a diagnosis of plantar fasciitis can usually be made based on a person's medical history and physical examination.<ref name="ACOEMfive">{{Citation |author1 = American College of Occupational and Environmental Medicine |author1-link = American College of Occupational and Environmental Medicine |date = February 2014 |title = Five Things Physicians and Patients Should Question |publisher = American College of Occupational and Environmental Medicine |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-occupational-and-environmental-medicine/ |access-date = 24 February 2014 |url-status=live |archive-url = https://web.archive.org/web/20140911001813/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-occupational-and-environmental-medicine/ |archive-date = 11 September 2014 }}, which cites
* {{cite book | vauthors = Haas N, Beecher P, Easly M | veditors = Hegmann KT |title=Occupational medicine practice guidelines : evaluation and management of common health problems and functional recovery in workers|date=2011|publisher=American College of Occupational and Environmental Medicine |chapter=Ankle and foot disorders |page=1182 |location=Elk Grove Village, IL|isbn=978-0615452272|edition=3rd|display-authors=etal}}</ref> When a physician suspects a fracture, infection, or some other serious underlying condition, they may order an X-ray to investigate.<ref name="ACOEMfive"/> X-rays are unnecessary to screen for plantar fasciitis for people who stand or walk a lot at work unless imaging is otherwise indicated.<ref name="ACOEMfive"/>

==Treatment==
===Non-surgical===
About 90% of plantar fasciitis cases improve within six months with conservative treatment,<ref name="Zhiyun_2013"/> and within a year regardless of treatment.<ref name="Goff_2011"/><ref name="Tahririan_2012"/>

The recommended first treatment is a four- to six-week course which combines three elements: daily [[stretching]], daily foot taping (using a special tape around the foot for supporting the [[Arches of the foot|arch]]) and individually tailored education on choosing footwear and other ways of managing the condition.<ref name="NIHR_2021">{{Cite journal |date=2022-07-21 |title=A best practice guide for managing plantar heel pain |url=https://evidence.nihr.ac.uk/alert/best-practice-guide-for-plantar-heel-pain/ |journal=NIHR Evidence |type=Plain English summary |language=en |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_52045|s2cid=251780089 |url-access=subscription }}</ref><ref name="Morrissey_2021">{{cite journal | vauthors = Morrissey D, Cotchett M, Said J'Bari A, Prior T, Griffiths IB, Rathleff MS, Gulle H, Vicenzino B, Barton CJ | display-authors = 6 | title = Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values | journal = British Journal of Sports Medicine | volume = 55 | issue = 19 | pages = 1106–1118 | date = October 2021 | pmid = 33785535 | pmc = 8458083 | doi = 10.1136/bjsports-2019-101970 }}</ref>

Reduction in pain and stress on the plantar fascia can be done by strengthening the muscles in the foot that support the arches through barefoot exercising, without footwear, compared to exercising in common footwear.<ref>{{Cite journal | vauthors = Kamalakannan M, Dass D |date=2019 |title=Efficacy of Bare foot Exercise Versus Common Footwear Exercise in Subjects with Plantar Fasciitis |url=http://www.indianjournals.com/ijor.aspx?target=ijor:rjpt&volume=12&issue=3&article=010 |journal=Research Journal of Pharmacy and Technology |language=en |volume=12 |issue=3 |pages=1039 |doi=10.5958/0974-360X.2019.00171.9 |s2cid=181730696 |issn=0974-3618|url-access=subscription }}</ref>

If plantar fasciitis fails to respond to conservative treatment for at least three months, then [[extracorporeal shockwave therapy]] (ESWT) may be considered.<ref name="NIHR_2021" /><ref name="Morrissey_2021" /> Evidence from [[meta analysis|meta-analyses]] suggests significant pain relief lasts up to one year after the procedure.<ref name="Zhiyun_2013" /><ref name="Aqil_2013">{{cite journal | vauthors = Aqil A, Siddiqui MR, Solan M, Redfern DJ, Gulati V, Cobb JP | title = Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs | journal = Clinical Orthopaedics and Related Research | volume = 471 | issue = 11 | pages = 3645–3652 | date = November 2013 | pmid = 23813184 | pmc = 3792262 | doi = 10.1007/s11999-013-3132-2 }}</ref>  However, debate about the therapy's efficacy has persisted.<ref name="Lareau_2014" /> ESWT is performed with or without [[anesthesia]] though studies suggest giving anesthesia diminishes the procedure's effectiveness.<ref name="Wang_2012">{{cite journal | vauthors = Wang CJ | title = Extracorporeal shockwave therapy in musculoskeletal disorders | journal = Journal of Orthopaedic Surgery and Research | volume = 7 | issue = 1 | pages = 11 | date = March 2012 | pmid = 22433113 | pmc = 3342893 | doi = 10.1186/1749-799X-7-11 | doi-access = free }}</ref> Complications from ESWT are rare and typically benign when present.<ref name="Wang_2012" /> Known complications of ESWT include the development of a mild [[hematoma]] or an [[ecchymosis]], [[Erythema|redness]] around the site of the procedure, or [[migraine]].<ref name="Wang_2012" />
[[File:Orthese am Strand.jpg|thumb|270x270px|Customised foot orthoses can offer short-term pain relief.]]
The third line of treatment, if shockwave therapy is not effective after around 8 weeks, is using customised foot [[Orthotics|orthoses]] which can offer short-term relief from pain.<ref name="NIHR_2021" /><ref name="Morrissey_2021" />

Affected people use further different treatments for plantar fasciitis but many have little evidence to support their use and are not adequately studied.<ref name="Goff_2011" />

Other conservative approaches include rest, [[massage]], heat, ice, and [[calf raises|calf-strengthening exercises]], weight reduction in the overweight or obese, and [[nonsteroidal anti-inflammatory drugs]] (NSAIDs) such as [[aspirin]] or [[ibuprofen]].<ref name="Tu_2011" /><ref name="Molloy_2012" /><ref>{{cite web |year=2010 |title=Plantar Fasciitis and Bone Spurs |url=http://orthoinfo.aaos.org/topic.cfm?topic=a00149 |url-status=live |archive-url=https://web.archive.org/web/20140616011951/http://orthoinfo.aaos.org/topic.cfm?topic=a00149 |archive-date=16 June 2014 |access-date=24 June 2014 |publisher=American Academy of Orthopaedic Surgeons}}</ref> The use of NSAIDs to treat plantar fasciitis is common, but their use fails to resolve the pain in 20% of people.<ref name="Molloy_2012" />

[[Corticosteroid]] injections are sometimes used for cases of plantar fasciitis that have proven resistant to more conservative measures. There is tentative evidence that injected corticosteroids are effective for short-term pain relief up to one month, but not after that.<ref>{{cite journal | vauthors = David JA, Sankarapandian V, Christopher PR, Chatterjee A, Macaden AS | title = Injected corticosteroids for treating plantar heel pain in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 6 | pages = CD009348 | date = June 2017 | pmid = 28602048 | pmc = 6481652 | doi = 10.1002/14651858.CD009348.pub2 }}</ref>

Another treatment technique is known as plantar [[iontophoresis]]. This technique involves applying anti-inflammatory substances such as [[dexamethasone]] or [[acetic acid]] topically to the foot and transmitting these substances through the skin with an electric current.<ref name="Molloy_2012"/> Some evidence supports the use of night splints for 1–3 months to relieve plantar fasciitis pain that has persisted for six months.<ref name="Tahririan_2012"/> The night splints are designed to position and maintain the ankle in a neutral position, thereby passively stretching the calf and plantar fascia during sleep.<ref name="Tahririan_2012"/>

===Surgery===
Plantar [[fasciotomy]] is a surgical treatment and the last resort for refractory plantar fasciitis pain. If plantar fasciitis does not resolve after six months of conservative treatment, then the procedure is considered as a last resort.<ref name="Goff_2011"/><ref name="Tu_2011"/> Minimally invasive and endoscopic approaches to plantar fasciotomy exist but require a specialist who is familiar with specific equipment. The availability of these surgical techniques is limited as of 2012.<ref name="Cutts_2012"/> A 2012 study found 76% of people who underwent endoscopic plantar fasciotomy had complete relief of their symptoms and had few complications (level IV evidence).<ref name="Lareau_2014"/> [[Heel spur]] removal during plantar fasciotomy does not appear to improve the surgical outcome.<ref name="Thomas_2010">{{cite journal | vauthors = Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, Weil LS, Zlotoff HJ, Bouché R, Baker J | display-authors = 6 | title = The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010 | journal = The Journal of Foot and Ankle Surgery | volume = 49 | issue = 3 Suppl | pages = S1-19 | date = May–June 2010 | pmid = 20439021 | doi = 10.1053/j.jfas.2010.01.001 | s2cid = 3199352 | doi-access = free }}</ref>

Plantar heel pain may occur for multiple reasons. In select cases, surgeons may perform a release of the [[lateral plantar nerve]] alongside the plantar fasciotomy.<ref name="Cutts_2012"/><ref name="Thomas_2010"/> Possible complications of plantar fasciotomy include nerve injury, instability of the [[medial longitudinal arch]] of the foot,<ref name="Tweed_2009">{{cite journal | vauthors = Tweed JL, Barnes MR, Allen MJ, Campbell JA | title = Biomechanical consequences of total plantar fasciotomy: a review of the literature | journal = Journal of the American Podiatric Medical Association | volume = 99 | issue = 5 | pages = 422–430 | date = September–October 2009 | pmid = 19767549 | doi = 10.7547/0990422 }}</ref> fracture of the [[calcaneus]], prolonged recovery time, infection, rupture of the plantar fascia, and failure to improve the pain.<ref name="Goff_2011"/> [[Radiofrequency ablation|Coblation]] surgery has recently been proposed as an alternative surgical approach for the treatment of recalcitrant plantar fasciitis.<ref name="Thomas_2010"/>

Gastrocnemius recession is a surgical procedure that involves lengthening the [[gastrocnemius muscle]] to reduce tension in the Achilles tendon and plantar fascia. This technique improves the ankle's range of motion, reduces pain, and can help patients return to work, sports, and weight-bearing activities more comfortably. The procedure is particularly beneficial for individuals with limited ankle dorsiflexion (upward bending) due to tight calf muscles, which can exacerbate plantar fasciitis symptoms.<ref>{{cite journal | vauthors = Arshad Z, Aslam A, Razzaq MA, Bhatia M | title = Gastrocnemius Release in the Management of Chronic Plantar Fasciitis: A Systematic Review | journal = Foot & Ankle International | volume = 43 | issue = 4 | pages = 568–575 | date = April 2022 | pmid = 34766860 | pmc = 8996295 | doi = 10.1177/10711007211052290 }}</ref>

===Unproven treatments===
[[Botulinum toxin]] A injections as well as similar techniques such as [[platelet-rich plasma]] injections and [[prolotherapy]] remain controversial.<ref name="Tahririan_2012"/><ref name="Lareau_2014"/><ref name="Molloy_2012"/><ref name=Monto>{{cite journal | vauthors = Monto RR | title = Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis | journal = Foot & Ankle International | volume = 35 | issue = 4 | pages = 313–318 | date = April 2014 | pmid = 24419823 | doi = 10.1177/1071100713519778 | s2cid = 206652513 }}</ref>

[[Dry needling]] is also being researched for treatment of plantar fasciitis.<ref>{{cite journal | vauthors = Cotchett MP, Landorf KB, Munteanu SE, Raspovic A | title = Effectiveness of trigger point dry needling for plantar heel pain: study protocol for a randomised controlled trial | journal = Journal of Foot and Ankle Research | volume = 4 | issue = 1 | pages = 5 | date = January 2011 | pmid = 21255460 | pmc = 3035595 | doi = 10.1186/1757-1146-4-5 | doi-access = free }}</ref> A [[systematic review]] of available research found limited evidence of effectiveness for this technique.<ref name=Cotchett/> The studies were reported to be inadequate in quality and too diverse in methodology for a firm conclusion.<ref name=Cotchett>{{cite journal | vauthors = Cotchett MP, Landorf KB, Munteanu SE | title = Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review | journal = Journal of Foot and Ankle Research | volume = 3 | issue = 1 | pages = 18 | date = September 2010 | pmid = 20807448 | pmc = 2942821 | doi = 10.1186/1757-1146-3-18 | doi-access = free }}</ref>

A combination of plantar fasciitis stretching and the use of botulinum toxin showed an increase in improvement and functionability in patients.<ref>{{Cite journal |last1=Elizondo-Rodriguez |first1=Jorge |last2=Araujo-Lopez |first2=Yariel |last3=Moreno-Gonzalez |first3=J. Alberto |last4=Cardenas-Estrada |first4=Eloy |last5=Mendoza-Lemus |first5=Oscar |last6=Acosta-Olivo |first6=Carlos |date=January 2013 |title=A Comparison of Botulinum Toxin A and Intralesional Steroids for the Treatment of Plantar Fasciitis: A Randomized, Double-Blinded Study |url=http://journals.sagepub.com/doi/10.1177/1071100712460215 |journal=Foot & Ankle International |language=en |volume=34 |issue=1 |pages=8–14 |doi=10.1177/1071100712460215 |pmid=23386757 |issn=1071-1007|url-access=subscription }}</ref>

==Epidemiology==
Plantar fasciitis is the most common type of plantar fascia injury<ref name="Jeswani_2009"/> and is the most common reason for heel pain, responsible for 80% of cases. The condition tends to occur more often in women, military recruits, older athletes, dancers,<ref name="Toronto_2017">{{cite book | vauthors = Kim J, Mukovozov I |title=Toronto Notes 2017: Comprehensive Medical Reference and Review for the Medical Council of Canada Qualifying Exam Part I and the United States Medical Licensing Exam Step 2 |year=2017 |publisher=Toronto Notes for Medical Students Incorporated |isbn=978-1-927363-34-8 }}{{page needed|date=August 2020}}</ref> people with obesity, and young male athletes.<ref name="Tahririan_2012"/><ref name="Monto_2013">{{cite journal | vauthors = Monto RR | title = Platelet-rich plasma and plantar fasciitis | journal = Sports Medicine and Arthroscopy Review | volume = 21 | issue = 4 | pages = 220–224 | date = December 2013 | pmid = 24212370 | doi = 10.1097/JSA.0b013e318297fa8d | s2cid = 5968932 }}</ref><ref name="Orchard_2012"/>

Plantar fasciitis is estimated to affect 1 in 10 people at some point during their lifetime and most commonly affects people between 40 and 60 years of age.<ref name="Rosenbaum_2014"/><ref name="Lareau_2014"/> In the United States alone, more than two million people receive treatment for plantar fasciitis.<ref name="Rosenbaum_2014"/> The cost of treating plantar fasciitis in the United States is estimated to be $284 million each year.<ref name="Rosenbaum_2014"/>

=== Prognosis ===
According to studies following patients with plantar fasciitis over several years, 20% to 75% of individuals no longer have any symptoms within a maximum of one year after the onset of symptoms.<ref name = "Hansen_2018">{{cite journal | vauthors = Hansen L, Krogh TP, Ellingsen T, Bolvig L, Fredberg U | title = Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination | journal = Orthopaedic Journal of Sports Medicine | volume = 6 | issue = 3 | pages = 2325967118757983 | date = March 2018 | pmid = 29536022 | pmc = 5844527 | doi = 10.1177/2325967118757983 }}</ref><ref>{{cite book  | vauthors = Buchanan BK, Kushner D |title= Plantar Fasciitis |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK431073/ |work=StatPearls |access-date=2023-07-15 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=28613727 }}</ref>

Having a [[Heel Spur|heel spur]] (bony protrusion at the heel) in addition to heel pain does not worsen the prognosis of recovery. Individuals with and without heel spurs recover at the same rate.<ref name = "Hansen_2018" />

{{clear}}

== References ==
 {{Reflist}}

== Further reading ==
{{refbegin}}
* {{cite journal | vauthors = Lee SY, McKeon P, Hertel J | title = Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis | journal = Physical Therapy in Sport | volume = 10 | issue = 1 | pages = 12–18 | date = February 2009 | pmid = 19218074 | doi = 10.1016/j.ptsp.2008.09.002 }}
{{refend}}

== External links ==
{{commons category}}
* {{cite web |title=Plantar fasciitis and bone spurs |publisher=[[American Academy of Orthopedic Surgeons]] |url=http://orthoinfo.aaos.org/topic.cfm?topic=a00149}}

{{Medical condition classification and resources
 |DiseasesDB     = 10114
 |ICD10          = {{ICD10|M|72|2|m|70}}
 |ICD9           = {{ICD9|728.71}}
 |ICDO           =
 |OMIM           =
 |MedlinePlus    = 007021
 |eMedicine_mult = {{eMedicine2|orthoped|142}}
 |eMedicineSubj  = pmr
 |eMedicineTopic = 107
 |MeSH=D036981
}}
{{Soft tissue disorders}}

{{DEFAULTSORT:Plantar Fasciitis}}
[[Category:Articles containing video clips]]
[[Category:Disorders of fascia]]
[[Category:Foot diseases]]
[[Category:Inflammations|Fasciitis, plantar]]
[[Category:Overuse injuries]]
[[Category:Wikipedia emergency medicine articles ready to translate]]
[[Category:Soft tissue disorders]]
[[Category:Wikipedia medicine articles ready to translate]]