Recent updates in the management of plantar fasciitis

Abstract

Proximal plantar fasciitis is the most common cause of plantar heel pain and can be quite debilitating. Usually it is diagnosed clinically and is self-limited. Historically, little high quality evidence has been available to guide treatment of chronic plantar fasciitis. Nonoperative methods are the first line of treatment, and surgery is reserved only for those in whom an optimized nonoperative treatment regimen has failed. Nonoperative treatments include stretching, orthotics, casting, anti-inflammatories, steroid injections and extracorporeal shock wave therapy. Recent Level I and II studies have demonstrated the benefits of including a plantar fascia specific stretch in nonoperative protocols. Surgical options are many, but consistent, high-quality evidence to guide treatment is lacking. This article will briefly review the anatomy, etiology and diagnosis of plantar fasciitis while focusing on nonoperative and operative treatments. The most recent literature will be reviewed to help guide the selection of optimal therapeutic regimens.