Clinical Review

Plantar fasciitis

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6603 (Published 10 October 2012) Cite this as: BMJ 2012;345:e6603
  1. John Orchard, sports physician
  1. 1Sports Clinic, University of Sydney, Camperdown, Sydney, NSW 2006, Australia
  1. johnorchard{at}msn.com.au

Summary points

  • Plantar fasciitis is a condition which generally resolves over time with minimally-invasive management

  • There is no one treatment with the highest level of evidence, but several with moderate levels of evidence, including stretching, orthotics, shock wave therapy, and injections

  • The secondary cost of prolonged immobility can be severe (and can also worsen plantar fasciitis), so it is worth treating plantar fasciitis actively rather than with neglect

  • Choice of treatments should be tailored to the individual patient’s circumstances and likelihood of response

Plantar fasciitis unfortunately has the reputation of being a trivial condition clinically, in that it is described as benign and self limiting1 2 with limited evidence to support any of the common treatments.3 However, the medical profession is starting to appreciate that the greatest public health challenge in Western countries is physical inactivity.4 In this context, plantar fasciitis, which inhibits physical activity due to pain, can be given its due respect.5 Many patients who develop plantar fasciitis are already overweight.6 Once everyday walking becomes painful, the difficulty in losing weight is extreme and the risk of gaining further weight increases, contributing to a worsening of the condition. Since being inactive and overweight are major risk factors for many diseases, an efficient treatment paradigm for plantar fasciitis—as opposed to a “wait and see” approach—becomes essential.

This review aims to assist the clinician in prioritising the most promising treatment options for a specific patient, rather than providing a comprehensive list of all the options with little guidance as to where to start in an individual case.

Sources and selection criteria

I conducted a PubMed search for “Plantar fasciitis”, yielding 358 references (9 March 2012). The systematic reviews retrieved from this search and other sources (including reference lists of above papers) were examined to establish the standard, commonly recommended treatments for …

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