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Plantar fasciitis

What's new

Updated 2023 APTA guidelines for the management of plantar fasciitis.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of plantar fasciitis are prepared by our editorial team based on guidelines from the American Physical Therapy Association (APTA 2023,2014), the American College of Radiology (ACR 2020), the American Academy of Family Physicians (AAFP 2019), and the American College of Foot and Ankle Surgeons (ACFAS 2018). ...
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Screening and diagnosis

Pathogenesis: as per ACFAS 2018 guidelines, recognize that infracalcaneal heel pain is a soft tissue-based disorder in most cases, and calcaneal spurring is most likely not a causative factor.
E
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  • Differential diagnosis

Classification and risk stratification

Risk factors: as per APTA 2014 guidelines, assess for limited ankle dorsiflexion ROM, high BMI in nonathletic individuals, running, and work-related weight-bearing activities (particularly under conditions with poor shock absorption) as risk factors for the development of heel pain/plantar fasciitis.
B

Diagnostic investigations

History and physical examination
As per ACFAS 2018 guidelines:
Elicit history and perform a physical examination to establish the diagnosis of plantar fasciitis in most cases.
E
Assess the chronicity of symptoms to guide the treatment for plantar fasciitis.
E

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  • Diagnostic imaging (X-ray)

  • Diagnostic imaging (MRI/ultrasound)

Medical management

NSAIDs: as per ACFAS 2018 guidelines, insufficient evidence to support the use of NSAIDs for pain in patients with plantar fasciitis.
I

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  • Intralesional corticosteroid injections

  • Other intralesional injections

Nonpharmacologic interventions

Exercise: as per APTA 2023 guidelines, consider offering therapeutic exercise including resistance training for the musculature of the foot and ankle.
C

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  • Stretching

  • Taping and orthoses

  • Night splints

  • Manual therapy

  • Dry needling

Therapeutic procedures

Extracorporeal shock wave therapy: as per AAFP 2019 guidelines, consider offering extracorporeal shock wave therapy in patients with chronic plantar fasciitis not responding to conservative therapies.
C

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  • Low-level laser therapy

  • Iontophoresis and phonophoresis

  • Therapeutic ultrasound

Surgical interventions

Indications for surgery
As per ACFAS 2018 guidelines:
Consider offering plantar fasciotomy (open or endoscopic) as an option in patients with chronic, refractory plantar fasciitis.
E
Consider offering gastrocnemius release as an option in patients with chronic, refractory plantar fasciitis in the presence of clinically significant equinus.
E

Patient education

General counseling: as per APTA 2023 guidelines, consider providing education and counseling on exercise strategies to gain or maintain optimal lean body mass in patients with heel pain/plantar fasciitis. Consider referring patients to an appropriate healthcare practitioner to address nutrition issues.
C

Follow-up and surveillance

Assessment of treatment response: as per APTA 2014 guidelines, use the FAAM, FHSQ, or the FFI and consider using the computer-adaptive version of the LEFS after interventions intended to alleviate the physical impairments, activity limitations, and participation restrictions associated with heel pain/plantar fasciitis.
A
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