Plantar Fasciitis Clinical Presentation

  • Author: Craig C Young, MD; Chief Editor: Craig C Young, MD   more...
 
Updated: Nov 4, 2011
 

History

The sine qua non of plantar fasciitis is a history of intense sharp heel pain with the first couple of steps in the morning or after other long periods without weight-bearing.[7] Pain is experienced primarily on the plantar surface of the foot at the anterior aspect of the calcaneus, but it may radiate proximally in more severe cases. A limp may be present, and patients may prefer to walk on their toes. Associated paresthesias, nocturnal pain, or systemic symptoms should raise suspicion of other causes of heel pain (ie, neoplastic, infectious, neurologic causes).

Initially, the pain decreases with ambulation or athletic warmup, but then increases throughout the day as activity increases. In more severe cases, patients complain of heel pain after periods of prolonged sitting. A dull ache may be felt in the heel at the end of the day, especially after extensive walking or standing. In addition to pain, patients may complain of stiffness in the foot and localized swelling in the heel.

An important element in the history is the period preceding the start of plantar fasciitis. Patients may report that before the onset of pain, they had increased the amount or intensity of activity including, but not limited to, running or walking. They may have also started exercising on a different type of surface or may have recently changed footwear (eg, started a barefoot style running program). They may have sustained previous trauma to the foot (eg, falls, motor vehicle accidents, work-related injuries).

Any precipitating factors should be identified if possible. Ask the patient what makes the pain worse and what makes it better.

  • Most patients report that the pain usually is most severe during the first few steps after prolonged inactivity, such as sleeping or sitting
  • Patients may report that symptoms typically are relieved by unloading the affected foot (via sitting, elevation, or other means)
  • Pain may be worsened by walking barefoot on hard surfaces or by walking up stairs
  • In athletes, the pain may be particularly aggravated by sprinting
  • Patients who are generally on their feet all day report that the symptoms may actually worsen by the end of the day

If this condition occurred in the course of the patient’s employment, then it may be considered a worker’s compensation issue. The physician should obtain a thorough history of the onset of the pain, any previous diagnostic assessment and/or treatments, and current functional capacities. This history is important for potential medicolegal purposes, such as impairment ratings.

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Physical Examination

The pain of plantar fasciitis can usually be reproduced by palpating the plantar-medial calcaneal tubercle at the site of plantar fascial insertion to the heel bone.[8] Less frequently, the pain will localize directly below the heel bone or even in the midsubstance of the plantar arch. In more severe cases, pain may be reproduced by palpation over the proximal portion of the plantar fascia.

A tight Achilles tendon (as in talipes equinus) is commonly a secondary finding and usually contributes to the pathology[8, 24] ; ankle dorsiflexion may be limited as a result. Other findings may include various deformities, skin changes, and flat-foot or pes planus foot type, overpronation, pes cavus or high-arched foot type, leg-length discrepancy, excessive lateral tibial torsion, and excessive femoral anteversion.

Other maneuvers that may reproduce the pain of plantar fasciitis include passive dorsiflexion of the toes, which is sometimes called the windlass test, and having the patient stand on the tiptoes and toe-walk. In a study by De Garceau et al, having the patient bear weight during the windlass test (see the image below) increased the sensitivity of the test from 13.6% to 31.8%.[25]

Weight-bearing windlass test. Weight-bearing windlass test.

To ensure that the patient is not presenting with retrocalcaneal bursitis or Achilles tendonitis, the clinician also should palpate the posterior aspect of the heel and ankle to look for tenderness.

Reproduction of pain in the forefoot by compressing together the metatarsal heads of the second and third or the third and fourth toes suggests the presence of a Morton neuroma and is not a typical finding in plantar fasciitis. Morton neuroma is due to the entrapment of the common digital nerve between the metatarsal heads.

A full musculoskeletal examination, including range of motion of hind-foot joints and medial-to-lateral squeeze of the calcaneus, aids further in diagnosis. Pain with compression is more frequently seen in stress fracture.

Tarsal tunnel syndrome can be ruled out by percussing over the tarsal tunnel behind the medial malleolus. This test produces no pain in patients with plantar fasciitis. To rule out an S1 radiculopathy, perform the straight leg raise test, the Achilles tendon reflex, and calf strength assessment with toe-walking, or 1-legged heel raises. In patients with plantar fasciitis, the results of all of these tests are be within the reference range.

The vascular examination includes palpation of the foot and ankle pulses. The Perthes test can be used to determine whether tortuous varicosities are contributing to the medial heel pain. In this test, a blood pressure cuff is inflated just proximal to the ankle at a pressure just below the patient’s systolic pressure, causing engorgement of symptomatic varicosities that may be entrapping the tibial nerve or causing claudication-type symptoms.

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Complications

In rare cases, the plantar fascia may rupture spontaneously. The risk of such a rupture is greatly increased by a history of treatment with a corticosteroid injection.[26] Long-term sequelae of rupture occur in approximately 50% of the patients who have a plantar fascia rupture.[26, 27] Moreover, longitudinal arch strain accounts for over 50% of the chronic complications of plantar fascia rupture.[26, 27]

Corticosteroid injection into the superficial fat pad may cause fat pad necrosis, due to loss of the shock absorption normally provided by the superficial fat pad, with subsequent pain during the early part of stance phase with ambulation. This development could create a significant disability in the event of a worker’s compensation case.

Potential complications include flattening of the longitudinal arch and heel hypoesthesia, as well as the potential complications that are associated with plantar fascia rupture. Longitudinal arch strain appears to account for over 50% of the chronic complications.[26, 27]

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Contributor Information and Disclosures
Author

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Gregory C Berlet, MD, FRCS(C) Clinical Assistant Professor of Orthopedics, Chief of Foot and Ankle Surgery, Department of Orthopedic Surgery, Ohio State University College of Medicine and Public Health

Gregory C Berlet, MD, FRCS(C) is a member of the following medical societies: American Medical Association, American Orthopaedic Foot and Ankle Society, Canadian Medical Association, Canadian Orthopaedic Association, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Jason H Calhoun, MD, FACS Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association

Disclosure: Nothing to disclose.

William T DeCarbo, DPM Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center

William T DeCarbo, DPM is a member of the following medical societies: American College of Foot and Ankle Surgeons and American Podiatric Medical Association

Disclosure: Nothing to disclose.

James K DeOrio, MD Director of Foot and Ankle Fellowship Program, Assistant Professor of Orthopedic Surgery, Orthopedic Surgery, St Lukes Hospital, Jacksonville, Florida

James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Florida Medical Association, and German Society of Neurology

Disclosure: Nothing to disclose.

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

Joseph P Garry, MD, FACSM, FAAFP Associate Professor, Sports Medicine Faculty, Department of Family & Community Medicine, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group

Disclosure: Nothing to disclose.

Shepard R Hurwitz, MD Executive Director, American Board of Orthopaedic Surgery

Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Christopher F Hyer, DPM, FACFAS Foot and Ankle Surgeon, Director, Advanced Foot and Ankle Surgery Fellowship, Orthopedic Foot and Ankle Center

Christopher F Hyer, DPM, FACFAS is a member of the following medical societies: American College of Foot and Ankle Surgeons and American Podiatric Medical Association

Disclosure: Wright Medical Technology Consulting fee Consulting; Wright Medical Technology Royalty Consulting; Orthopaedic Research and Education Foundation Grant/research funds Co-Investigator

Rick Kulkarni, MD

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Leslie Milne, MD Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine

Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Mark A Silverberg, MD, FACEP, MMB Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn

Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Deepika Singh, MD Staff Physician, Department of Emergency Medicine, Lawrence and Memorial Hospital, New London, CT

Deepika Singh, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Nurses Association, Emergency Medicine Residents Association, and Sigma Theta Tau International

Disclosure: Nothing to disclose.

Matthew D Sorensen, DPM Foot and Ankle Surgeon, Summit Orthopedics

Matthew D Sorensen, DPM is a member of the following medical societies: American College of Foot and Ankle Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Russell D White, MD Professor of Medicine, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

References

  1. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. May 2004;25(5):303-10. [Medline].

  2. Tong KB, Furia J. Economic burden of plantar fasciitis treatment in the United States. Am J Orthop (Belle Mead NJ). May 2010;39(5):227-31. [Medline].

  3. Singh D, Angel J, Bentley G, Trevino SG. Fortnightly review. Plantar fasciitis. BMJ. Jul 19 1997;315(7101):172-5. [Medline]. [Full Text].

  4. Lennard TA. Fundamentals of procedural care. In: Lennard TA, ed. Physiatric Procedures in Clinical Practic. Philadelphia: Hanley & Belfus; 1995:1-13.

  5. Williams PL, Warwick R. Myology. In: Gray's Anatomy. 36. Philadelphia: WB Saunders; 1980:612-613.

  6. HICKS JH. The mechanics of the foot. II. The plantar aponeurosis and the arch. J Anat. Jan 1954;88(1):25-30. [Medline]. [Full Text].

  7. Young CC, Rutherford DS, Niedfeldt MW. Treatment of plantar fasciitis. Am Fam Physician. Feb 1 2001;63(3):467-74, 477-8. [Medline]. [Full Text].

  8. Boberg J, Dauphinee D. Plantar Heel. In: Banks AM, Downey D, Martin S, Miller. McGlamry's Comprehensive Textbook of Foot and Ankle Surgery. 1. 3. Philadelphia: Lippincott Williams & Wilkins; 2001:471.

  9. Woelffer KE, Figura MA, Sandberg NS, Snyder NS. Five-year follow-up results of instep plantar fasciotomy for chronic heel pain. J Foot Ankle Surg. Jul-Aug 2000;39(4):218-23. [Medline].

  10. Sammarco GJ, Helfrey RB. Surgical treatment of recalcitrant plantar fasciitis. Foot Ankle Int. Sep 1996;17(9):520-6. [Medline].

  11. Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am. Feb 1999;81(2):259-78. [Medline].

  12. Khan KM, Cook JL, Kannus P, Maffulli N, Bonar SF. Time to abandon the "tendinitis" myth. BMJ. Mar 16 2002;324(7338):626-7. [Medline]. [Full Text].

  13. Khan KM, Cook JL, Bonar F, Harcourt P, Astrom M. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med. Jun 1999;27(6):393-408. [Medline].

  14. Alfredson H, Lorentzon R. Chronic Achilles tendinosis: recommendations for treatment and prevention. Sports Med. Feb 2000;29(2):135-46. [Medline].

  15. Tasto JP. The Use of Bipolar Radiofrequency Microtenotomy in the Treatment of Chronic Tendinosis of the Foot and Ankle. J Tech Foot Ankle Surg. 2006;5(2):110-116.

  16. Cavanagh PR, Lafortune MA. Ground reaction forces in distance running. J Biomech. 1980;13(5):397-406. [Medline].

  17. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. May 2003;85-A(5):872-7. [Medline].

  18. Werner RA, Gell N, Hartigan A, Wiggerman N, Keyserling WM. Risk factors for plantar fasciitis among assembly plant workers. PM R. Feb 2010;2(2):110-6; quiz 1 p following 167. [Medline].

  19. Reid DC. Running: injury patterns and prevention. Sports Injury Assessment and Rehabilitation. New York, NY: Churchill Livingstone; 1992:1131-58.

  20. Pohl MB, Hamill J, Davis IS. Biomechanical and anatomic factors associated with a history of plantar fasciitis in female runners. Clin J Sport Med. Sep 2009;19(5):372-6. [Medline].

  21. Moseley JB Jr, Chimenti BT. Foot and ankle injuries in the professional athlete. In: Baxter DE, ed. The Foot and Ankle in Sport. St. Louis, Mo: Mosby-Year Book; 1995:321-8.

  22. Wolgin M, Cook C, Graham C, Mauldin D. Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int. Mar 1994;15(3):97-102. [Medline].

  23. Martin RL, Irrgang JJ, Conti SF. Outcome study of subjects with insertional plantar fasciitis. Foot Ankle Int. Dec 1998;19(12):803-11. [Medline].

  24. The diagnosis and treatment of heel pain. J Foot Ankle Surg. Sep-Oct 2001;40(5):329-40. [Medline].

  25. De Garceau D, Dean D, Requejo SM, Thordarson DB. The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int. Mar 2003;24(3):251-5. [Medline].

  26. Acevedo JI, Beskin JL. Complications of plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. Feb 1998;19(2):91-7. [Medline].

  27. Sellman JR. Plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. Jul 1994;15(7):376-81. [Medline].

  28. McMillan AM, Landorf KB, Barrett JT, Menz HB, Bird AR. Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis. J Foot Ankle Res. Nov 13 2009;2:32. [Medline]. [Full Text].

  29. Mahowald S, Legge BS, Grady JF. The correlation between plantar fascia thickness and symptoms of plantar fasciitis. J Am Podiatr Med Assoc. Sep 2011;101(5):385-9. [Medline].

  30. DiMarcangelo MT, Yu TC. Diagnostic imaging of heel pain and plantar fasciitis. Clin Podiatr Med Surg. Apr 1997;14(2):281-301. [Medline].

  31. Barrett SL, Day SV, Pignetti TT, Egly BR. Endoscopic heel anatomy: analysis of 200 fresh frozen specimens. J Foot Ankle Surg. Jan-Feb 1995;34(1):51-6. [Medline].

  32. Furey JG. Plantar fasciitis. The painful heel syndrome. J Bone Joint Surg Am. Jul 1975;57(5):672-3. [Medline].

  33. Gill LH, Kiebzak GM. Outcome of nonsurgical treatment for plantar fasciitis. Foot Ankle Int. Sep 1996;17(9):527-32. [Medline].

  34. Davis PF, Severud E, Baxter DE. Painful heel syndrome: results of nonoperative treatment. Foot Ankle Int. Oct 1994;15(10):531-5. [Medline].

  35. McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain--plantar fasciitis: clinical practice guildelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. Apr 2008;38(4):A1-A18. [Medline].

  36. Quillen WS, Magee DJ, Zachazewski JE. The process of athletic injury and rehabilitation. Athletic Injuries and Rehabilitation. Philadelphia, Pa: WB Saunders Co; 1996:3-8.

  37. Stanley KL, Weaver JE. Pharmacologic management of pain and inflammation in athletes. Clin Sports Med. Apr 1998;17(2):375-92. [Medline].

  38. McCarthy D. Nonsteroidal anti-inflammatory drug-related gastrointestinal toxicity: definitions and epidemiology. Am J Med. Nov 2 1998;105(5A):3S-9S. [Medline].

  39. Theodore GH, Buch M, Amendola A, et al. Extracorporeal shock wave therapy for the treatment of plantar fasciitis. Foot Ankle Int. May 2004;25(5):290-7. [Medline].

  40. Mehra A, Zaman T, Jenkin AI. The use of a mobile lithotripter in the treatment of tennis elbow and plantar fasciitis. Surgeon. Oct 2003;1(5):290-2. [Medline].

  41. Crawford F, Atkins D, Young P, Edwards J. Steroid injection for heel pain: evidence of short-term effectiveness. A randomized controlled trial. Rheumatology (Oxford). Oct 1999;38(10):974-7. [Medline].

  42. Pfenninger JL. Joint and soft tissue aspiration and injection. In: Pfenninger JL, Fowler GC, eds. Procedures for Primary Care Physicians. St. Louis, Mo: Mosby-Year Book; 1994:1036-54.

  43. Yucel I, Yazici B, Degirmenci E, Erdogmus B, Dogan S. Comparison of ultrasound-, palpation-, and scintigraphy-guided steroid injections in the treatment of plantar fasciitis. Arch Orthop Trauma Surg. May 2009;129(5):695-701. [Medline].

  44. Kane D, Greaney T, Bresnihan B, Gibney R, FitzGerald O. Ultrasound guided injection of recalcitrant plantar fasciitis. Ann Rheum Dis. Jun 1998;57(6):383-4. [Medline]. [Full Text].

  45. Porter MD, Shadbolt B. Intralesional corticosteroid injection versus extracorporeal shock wave therapy for plantar fasciopathy. Clin J Sport Med. May 2005;15(3):119-24. [Medline].

  46. Govindarajan R, Bakalova T, Doss NW, Splain SH, Michael R, Abadir AR. Posterior tibial nerve block in the therapeutic management of painful calcaneal spur (plantar fasciitis): a preliminary experience. Can J Anaesth. Oct 2003;50(8):862-3. [Medline]. [Full Text].

  47. Tsai WC, Wang CL, Tang FT, et al. Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection. Arch Phys Med Rehabil. Oct 2000;81(10):1416-21. [Medline].

  48. Babcock MS, Foster L, Pasquina P, Jabbari B. Treatment of pain attributed to plantar fasciitis with botulinum toxin a: a short-term, randomized, placebo-controlled, double-blind study. Am J Phys Med Rehabil. Sep 2005;84(9):649-54. [Medline].

  49. Huang YC, Wei SH, Wang HK, Lieu FK. Ultrasonographic guided botulinum toxin type A treatment for plantar fasciitis: an outcome-based investigation for treating pain and gait changes. J Rehabil Med. Feb 2010;42(2):136-40. [Medline].

  50. Martin RP. Autologous blood injection for plantar fasciitis: a retrospective study. Paper presented at: Annual meeting of the American Medical Society for Sports Medicine; April 16-20, 2005; Austin, Texas. Clin J Sport Med. Sept 2005;15:387-8.

  51. Kiter E, Celikbas E, Akkaya S, Demirkan F, Kiliç BA. Comparison of injection modalities in the treatment of plantar heel pain: a randomized controlled trial. J Am Podiatr Med Assoc. Jul-Aug 2006;96(4):293-6. [Medline].

  52. Lee TG, Ahmad TS. Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis. A prospective, randomized, controlled trial. Foot Ankle Int. Sep 2007;28(9):984-90. [Medline].

  53. Peerbooms JC, van Laar W, Faber F, Schuller HM, van der Hoeven H, Gosens T. Use of platelet rich plasma to treat plantar fasciitis: design of a multi centre randomized controlled trial. BMC Musculoskelet Disord. Apr 14 2010;11:69. [Medline]. [Full Text].

  54. Ogden JA, Alvarez RG, Marlow M. Shockwave therapy for chronic proximal plantar fasciitis: a meta-analysis. Foot Ankle Int. Apr 2002;23(4):301-8. [Medline].

  55. Rompe JD, Decking J, Schoellner C, Nafe B. Shock wave application for chronic plantar fasciitis in running athletes. A prospective, randomized, placebo-controlled trial. Am J Sports Med. Mar-Apr 2003;31(2):268-75. [Medline].

  56. Hyer CF, Vancourt R, Block A. Evaluation of ultrasound-guided extracorporeal shock wave therapy (ESWT) in the treatment of chronic plantar fasciitis. J Foot Ankle Surg. Mar-Apr 2005;44(2):137-43. [Medline].

  57. Alvarez R., Cross, G.L., Levitt, R., Gould, et al. Chronic proximal Plantar Fasciitis Treatment Results with the Ossatron ESW System. FDA Investigational Study P990086, approval 10-12-2000. Accessed Sept. 15, 2002. Available at http://www.fda.gov/cdrh/pdf/p00086.html..

  58. Chuckpaiwong B, Berkson EM, Theodore GH. Extracorporeal shock wave for chronic proximal plantar fasciitis: 225 patients with results and outcome predictors. J Foot Ankle Surg. Mar-Apr 2009;48(2):148-55. [Medline].

  59. Ogden JA, Cross GL, Williams SS. Bilateral chronic proximal plantar fasciopathy: treatment with electrohydraulic orthotripsy. Foot Ankle Int. May 2004;25(5):298-302. [Medline].

  60. Ogden JA, Alvarez RG, Levitt RL, Johnson JE, Marlow ME. Electrohydraulic high-energy shock-wave treatment for chronic plantar fasciitis. J Bone Joint Surg Am. Oct 2004;86-A(10):2216-28. [Medline].

  61. Speed CA, Nichols D, Wies J, et al. Extracorporeal shock wave therapy for plantar fasciitis. A double blind randomised controlled trial. J Orthop Res. Sep 2003;21(5):937-40. [Medline].

  62. Hammer DS, Adam F, Kreutz A, Kohn D, Seil R. Extracorporeal shock wave therapy (ESWT) in patients with chronic proximal plantar fasciitis: a 2-year follow-up. Foot Ankle Int. Nov 2003;24(11):823-8. [Medline].

  63. Stratton M, McPoil TG, Cornwall MW, Patrick K. Use of low-frequency electrical stimulation for the treatment of plantar fasciitis. J Am Podiatr Med Assoc. Nov-Dec 2009;99(6):481-8. [Medline].

  64. Ibrahim MI, Donatelli RA, Schmitz C, Hellman MA, Buxbaum F. Chronic plantar fasciitis treated with two sessions of radial extracorporeal shock wave therapy. Foot Ankle Int. May 2010;31(5):391-7. [Medline].

  65. Mariotto S, de Prati AC, Cavalieri E, Amelio E, Marlinghaus E, Suzuki H. Extracorporeal shock wave therapy in inflammatory diseases: molecular mechanism that triggers anti-inflammatory action. Curr Med Chem. 2009;16(19):2366-2372.

  66. Lohrer H, Nauck T, Dorn-Lange NV, Schöll J, Vester JC. Comparison of radial versus focused extracorporeal shock waves in plantar fasciitis using functional measures. Foot Ankle Int. Jan 2010;31(1):1-9. [Medline].

  67. Greve JM, Grecco MV, Santos-Silva PR. Comparison of radial shockwaves and conventional physiotherapy for treating plantar fasciitis. Clinics (Sao Paulo). 2009;64(2):97-103. [Medline]. [Full Text].

  68. Dogramaci Y, Kalaci A, Emir A, Yanat AN, Gökçe A. Intracorporeal pneumatic shock application for the treatment of chronic plantar fasciitis: a randomized, double blind prospective clinical trial. Arch Orthop Trauma Surg. Aug 2009.

  69. Martin JE, Hosch JC, Goforth WP, Murff RT, Lynch DM, Odom RD. Mechanical treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc. Feb 2001;91(2):55-62. [Medline].

  70. Batt ME, Tanji JL, Skattum N. Plantar fasciitis: a prospective randomized clinical trial of the tension night splint. Clin J Sport Med. Jul 1996;6(3):158-62. [Medline].

  71. Wapner KL, Sharkey PF. The use of night splints for treatment of recalcitrant plantar fasciitis. Foot Ankle. Dec 1991;12(3):135-7. [Medline].

  72. Powell M, Post WR, Keener J, Wearden S. Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. Foot Ankle Int. Jan 1998;19(1):10-8. [Medline].

  73. Mizel MS, Marymont JV, Trepman E. Treatment of plantar fasciitis with a night splint and shoe modification consisting of a steel shank and anterior rocker bottom. Foot Ankle Int. Dec 1996;17(12):732-5. [Medline].

  74. Berlet GC, Anderson RB, Davis H, Kiebzak GM. A prospective trial of night splinting in the treatment of recalcitrant plantar fasciitis: the Ankle Dorsiflexion Dynasplint. Orthopedics. Nov 2002;25(11):1273-5. [Medline].

  75. Probe RA, Baca M, Adams R, Preece C. Night splint treatment for plantar fasciitis. A prospective randomized study. Clin Orthop Relat Res. Nov 1999;190-5. [Medline].

  76. Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med. Jun 26 2006;166(12):1305-10. [Medline].

  77. Caselli MA, Clark N, Lazarus S, Velez Z, Venegas L. Evaluation of magnetic foil and PPT Insoles in the treatment of heel pain. J Am Podiatr Med Assoc. Jan 1997;87(1):11-6. [Medline].

  78. Kogler GF, Solomonidis SE, Paul JP. Biomechanics of longitudinal arch support mechanisms in foot orthoses and their effect on plantar aponeurosis strain. Clin Biomech (Bristol, Avon). Jul 1996;11(5):243-252. [Medline].

  79. Kogler GF, Solomonidis SE, Paul JP. In vitro method for quantifying the effectiveness of the longitudinal arch support mechanism of a foot orthosis. Clin Biomech (Bristol, Avon). Jul 1995;10(5):245-252. [Medline].

  80. Lee SY, McKeon P, Hertel J. Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis. Phys Ther Sport. Feb 2009;10(1):12-8. [Medline].

  81. Baldassin V, Gomes CR, Beraldo PS. Effectiveness of prefabricated and customized foot orthoses made from low-cost foam for noncomplicated plantar fasciitis: a randomized controlled trial. Arch Phys Med Rehabil. April 2009;90(4):701-706.

  82. Lynch DM, Goforth WP, Martin JE, et al. Conservative treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc. Aug 1998;88(8):375-80. [Medline].

  83. van de Water AT, Speksnijder CM. Efficacy of taping for the treatment of plantar fasciosis: a systematic review of controlled trials. J Am Podiatr Med Assoc. Jan-Feb 2010;100(1):41-51. [Medline].

  84. Chia KK, Suresh S, Kuah A, Ong JL, Phua JM, Seah AL. Comparative trial of the foot pressure patterns between corrective orthotics,formthotics, bone spur pads and flat insoles in patients with chronic plantar fasciitis. Ann Acad Med Singapore. Oct 2009;38(10):869-75. [Medline].

  85. Kwong PK, Kay D, Voner RT, White MW. Plantar fasciitis. Mechanics and pathomechanics of treatment. Clin Sports Med. Jan 1988;7(1):119-26. [Medline].

  86. Gudeman SD, Eisele SA, Heidt RS Jr, Colosimo AJ, Stroupe AL. Treatment of plantar fasciitis by iontophoresis of 0.4% dexamethasone. A randomized, double-blind, placebo-controlled study. Am J Sports Med. May-Jun 1997;25(3):312-6. [Medline].

  87. Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord. Apr 19 2007;8:36. [Medline]. [Full Text].

  88. DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. Jul 2003;85-A(7):1270-7. [Medline].

  89. Miyamoto W, Takao M, Uchio Y. Calcaneal osteotomy for the treatment of plantar fasciitis. Arch Orthop Trauma Surg. Feb 2010;130(2):151-4. [Medline].

  90. Tomczak RL, Haverstock BD. A retrospective comparison of endoscopic plantar fasciotomy to open plantar fasciotomy with heel spur resection for chronic plantar fasciitis/heel spur syndrome. J Foot Ankle Surg. May-Jun 1995;34(3):305-11. [Medline].

  91. Kinley S, Frascone S, Calderone D, Wertheimer SJ, Squire MA, Wiseman FA. Endoscopic plantar fasciotomy versus traditional open heel spur surgery: a prospective study. J Foot Ankle Surg. 1993;32:595-603.

  92. Malay DS, Pressman MM, Assili A, et al. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial. J Foot Ankle Surg. Jul-Aug 2006;45(4):196-210. [Medline].

  93. Daly PJ, Kitaoka HB, Chao EY. Plantar fasciotomy for intractable plantar fasciitis: clinical results and biomechanical evaluation. Foot Ankle. May 1992;13(4):188-95. [Medline].

  94. Leach RE, Seavey MS, Salter DK. Results of surgery in athletes with plantar fasciitis. Foot Ankle. Dec 1986;7(3):156-61. [Medline].

  95. Benton-Weil W, Borrelli AH, Weil LS Jr, Weil LS Sr. Percutaneous plantar fasciotomy: a minimally invasive procedure for recalcitrant plantar fasciitis. J Foot Ankle Surg. Jul-Aug 1998;37(4):269-72. [Medline].

  96. Sollitto RJ, Plotkin EL, Klein PG, Mullin P. Early clinical results of the use of radiofrequency lesioning in the treatment of plantar fasciitis. J Foot Ankle Surg. May-Jun 1997;36(3):215-9; discussion 256. [Medline].

  97. Boyle RA, Slater GL. Endoscopic plantar fascia release: a case series. Foot Ankle Int. Feb 2003;24(2):176-9. [Medline].

  98. Conflitti JM, Tarquinio TA. Operative outcome of partial plantar fasciectomy and neurolysis to the nerve of the abductor digiti minimi muscle for recalcitrant plantar fasciitis. Foot Ankle Int. Jul 2004;25(7):482-7. [Medline].

  99. Jerosch J, Schunck J, Liebsch D, Filler T. Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (E FRPF). Knee Surg Sports Traumatol Arthrosc. Sep 2004;12(5):471-7. [Medline].

  100. Bazaz R, Ferkel RD. Results of endoscopic plantar fascia release. Foot Ankle Int. May 2007;28(5):549-56. [Medline].

  101. Debrule MB. Ultrasound-guided weil percutaneous plantar fasciotomy. J Am Podiatr Med Assoc. Mar-Apr 2010;100(2):146-8. [Medline].

  102. Allen BH, Fallat LM, Schwartz SM. Cryosurgery: an innovative technique for the treatment of plantar fasciitis. J Foot Ankle Surg. Mar-Apr 2007;46(2):75-9. [Medline].

  103. Cavazos GJ, Khan KH, D'Antoni AV, Harkless LB, Lopez D. Cryosurgery for the treatment of heel pain. Foot Ankle Int. Jun 2009;30(6):500-5. [Medline].

  104. Sorensen MD, Hyer CF. Bi-Polar Radiofrequency Microdebridement in the Treatment of Chronic Recalcitrant Plantar Fasciitis. Presented at the American College of Foot & Ankle Surgeons Annual Meeting, 2009, Washington, D.C.

  105. Liden B, Simmons M, Landsman AS. A retrospective analysis of 22 patients treated with percutaneous radiofrequency nerve ablation for prolonged moderate to severe heel pain associated with plantar fasciitis. J Foot Ankle Surg. Nov-Dec 2009;48(6):642-7. [Medline].

 
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Weight-bearing windlass test.
Calf stretch.
Towel curl.
Toe taps.
Night splint.
Low-dye taping method. This technique provides support for plantar fascia and helps reduce excessive pronation.
Example of arch support with cushioned heel. These are available in three-quarter or full lengths to fit in shoe.
Example of night splint. These are intended to prevent shortening of Achilles tendon and plantar fascia at night.
Orthosis
Night splint, designed to prevent shortening of Achilles tendon and plantar fascia at night.
Plantar fascia stretching exercise.
 
 
 
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