University of Iowa Family Practice Handbook, Fourth Edition, Chapter 16

Orthopedics: Heel Pain: Plantar Fasciitis

1. Clinically. Pain over the heel on weight bearing. The pain is especially severe in the morning and after protracted sitting. Passive dorsiflexion of the toes with foot eversion may exacerbate the pain. There may be associated pes planus.
2. Radiographs are generally not indicated. Radiographs may show a calcaneal spur but the spur is incidental and not the cause of the fasciitis.
3. Differential includes subcalcaneal bursitis and herniated calcaneal fat pad. These should not worsen with toe dorsiflexion. Additionally, calcaneal fat pad pain is maximally tender over the calcaneous while plantar fasciitis is more tender distal to the heel. Finally, calcaneal bursitis should be associated with a swelling over the calcaneous.
4. Treatment. Treatment for all of the above include NSAIDS, soaks, rest. For plantar fasciitis, consider orthotics to correct pes planus and a soft rubber heel cup (e.g., Tuli’s heel cup). Stretching of the fascia (lean forward against wall with heel on the ground) will help as will injection of corticosteroids. Surgery is rarely indicated.

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See related Provider Topics Bones, Joints and Muscles, Foot Injuries and Disorders or Injuries and Wounds.

See related Patient Topics Bones, Joints and Muscles or Injuries and Wounds.

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