Update on Plantar Fasciitis
In this update on plantar fasciitis, clinical guidelines for the evaluation and treatment of this condition are offered. The authors use the best evidence available to bring us up to date on the prevalence, pathologic process, and risk factors linked to plantar fasciitis. Examination, diagnosis, and treatment interventions are also summarized.

Heel pain is the most common symptom associated with plantar fasciitis. The pain occurs when putting weight on the feet after a long period of rest or immobility. Getting up in the morning and putting the feet on the floor evokes the strongest painful reaction. But symptoms are most pronounced after any period of time off the feet. And the pain gets worse after standing on the feet for too long.

Other factors that can increase the risk of developing plantar fasciitis include limited ankle motion and obesity. Obesity is determined by a body mass index (BMI) greater than 30 kg/m2. The clinician's examination will pay close attention to the presence ofany of these risk factors.

For anyone with this type of heel pain, there are other causes of heel pain that must be considered. These can include a stress fracture, bone bruise, nerve compression, or tumors. Pain can also be referred to the heel from a pinched nerve in the low back region.

X-rays may be used to look for heel spurs as a cause of the problem. But for the most part, imaging studies aren't needed to diagnose plantar fasciitis. The patient's history and clinical presentation are usually fairly obvious when it's plantar fasciitis. There are several tests used by doctors and physical therapists to identify the presence of plantar fasciitis.

Treatment is usually nonoperative. A physical therapist may use any number of different intervention methods. This may include modalities such as ultrasound or iontophoresis, manual therapy and mobilization, and stretching. Taping, orthotic devices (placed inside the shoe), and night splints may also be given a try. The authors describe in greater detail each type of treatment mentioned here.

The clinical guidelines for plantar fasciitis are simply that. They are not a gold standard that must be adhered to for every patient with plantar fasciitis. Guidelines are made on the basis of the most current evidence. As future studies are published, guidelines for examination, diagnosis, and treatment may change.

Therapists are advised to document in the patients' chart any changes made from the guidelines. Other acceptable methods of care may be used for some patients. Each clinician must make the best decision for each patient based on individual needs and differences.
Thomas G. McPoil, PT, PhD, et al. Clinical Guidelines. Heel Pain -- Plantar Fasciitis. In Journal of Orthopaedics & Sports Physical Therapy. April 2008. Vol. 38. No. 4. Pp. A1-A18.