Practice 10 minute consultation

Plantar heel pain

BMJ 2016; 353 doi: http://dx.doi.org/10.1136/bmj.i2175 (Published 03 June 2016) Cite this as: BMJ 2016;353:i2175
  1. Martin J Thomas, research fellow and physiotherapy clinical lecturer1,
  2. Hylton B Menz, professor1 2,
  3. Christian D Mallen, NIHR research professor general practice1
  1. 1Arthritis Research UK Primary Care Centre, Keele University, Keele ST5 5BG, UK
  2. 2Discipline of Podiatry and La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora 3086, Victoria, Australia
  1. Correspondence to: M J Thomas m.thomas{at}keele.ac.uk

What you need to know

  • The most common cause of plantar heel pain is plantar fasciitis

  • Trial self management for a few months with relative rest, simple analgesia, stretching, weight loss, insoles or arch supports, and footwear modification for patients with plantar fasciitis

A 56 year old retail manager complains of four months of pain under her left heel. It is worse first thing in the morning and after sitting.

What you should cover

About one in 10 people aged over 50 years report plantar heel pain.1 A recent ultrasound study of 175 feet with plantar heel pain in a secondary care population diagnosed plantar fasciitis in 73% of cases.2 The symptoms above are typical.

Take a history

Ask the patient where the pain is and what it feels like. Patients with plantar fasciitis typically describe a sharp pain under the heel. It may extend along the arch of the foot, from the insertion, along the length of the plantar fascia. Pain is worse when taking their initial steps in the morning and eases after a few minutes of walking, but it may return on weight bearing after periods of inactivity during the day. Symptoms are bilateral in about a third of cases.3

Explore alternative diagnoses. Trauma from landing on the heel from height can fracture the calcaneum, for example. Previous surgery to the area could lead to longstanding heel pain of iatrogenic causes. If there is pain elsewhere in the body, …

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