Plantar Fasciitis: Evidence-Based Treatment for Heel Pain

What Is Plantar Fasciitis?

Plantar fasciitis is the most common cause of heel pain, affecting approximately 1 in 10 people at some point in their lives. It involves degeneration and inflammation of the plantar fascia, the thick band of connective tissue running along the sole of the foot from the heel to the toes, at its origin on the heel bone.

Who Gets It?

Risk factors include obesity, prolonged standing or walking on hard surfaces, sudden increase in activity, tight calf muscles, and flat feet or high arches. It is common in runners, healthcare workers, and teachers. The peak incidence is in adults aged 40–60.

Symptoms

• Sharp, stabbing heel pain with the first steps in the morning — the hallmark symptom
• Pain improves after a few minutes of walking but may worsen after prolonged activity
• Pain after periods of sitting or rest
• Tenderness directly on the heel bone (calcaneal insertion)

Evidence-Based Treatment

The good news: approximately 90% of patients with plantar fasciitis improve with conservative treatment over 6–18 months. First-line treatments with strong evidence include:

• Calf and plantar fascia stretching — the most important intervention
• Plantar fascia-specific stretching (Stecco protocol)
• Supportive footwear and orthotics (particularly heel cups)
• NSAIDs for short-term pain relief
• Physiotherapy — progressive loading program

Additional Options

For persistent cases (beyond 6 months):

• Corticosteroid injection — effective short-term but risk of plantar fascia rupture
• Extracorporeal shockwave therapy (ESWT) — good evidence for chronic plantar fasciitis; non-invasive
• PRP injection — emerging evidence

Surgery

Surgical treatment is reserved for the small number of patients (approximately 5–10%) who fail to improve after 12–18 months of comprehensive conservative treatment. Endoscopic plantar fasciotomy (partial release of the plantar fascia) is the most common procedure. Results are good to excellent in well-selected patients.

Further Reading

Dr Smith has written in more detail about this topic on his own site: plantar fasciitis and keyhole plantar fascia surgery.