- 80% self-limiting and resolve with simple self-treatment
- Gradual onset with stiffness rising in the morning is typical of Achilles and plantar heel pain
- Usually worse on initial weight bearing in the morning, better throughout the day and increasing in the evening.
- Electric shock pain, reduced sensation or pain at rest indicate possible nerve entrapment or lumbar spine referral
- Tenderness at attachment of PF to medial calcaneal tubercle
- Fat pad atrophy with non-specific pain under heel
Plantar Heel Pain
Symptoms and signs
Initial management
- Provide with patient information leaflet for plantar fasciitis to aid self-management.
- Imaging is not indicated. No merit in XR to look for heel spur, the finding of a spur has no bearing on treatment
- Analgesia & NSAIDs as appropriate.
- Advise weight loss if appropriate
- Heel cushions
- Regular calf/ plantar fascia stretching
- Off the shelf In shoe orthosis (From Boots/Allardyce/PhysioMed)
- Consider steroid injection if skilled to do so.
Useful resources
NHS Tayside Patient Leaflet - Plantar Fasciitis (includes general advice, footwear recommendations and exercises)
NICE CKS Plantar Fasciitis info Includes summary management advice and links to exercises.
NICE CKS Plantar Fasciitis info Includes summary management advice and links to exercises.
Who to refer
If no improvement after 3 months conservative management.
How to refer
SCI Gateway/Orthopaedics/Foot and Ankle Service.
Referral will be vetted by AHP and directed to most appropriate professional (most likely AHP in first instance for assessment).
Referral will be vetted by AHP and directed to most appropriate professional (most likely AHP in first instance for assessment).