Heel Pain—Plantar Fasciitis

Publication Date: October 31, 2014

Recommendations

Risk Factors

Clinicians should assess the presence of limited ankle dorsiflexion range of motion, high body mass index 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)
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Diagnosis/Classification

Physical therapists should diagnose the International Classification of Diseases (ICD) category of plantar fasciitis and the associated International Classification of Functioning, Disability and Health (ICF) impairment-based category of heel pain (b28015 Pain in lower limb, b2804 Radiating pain in a segment or region) using the following history and physical examination findings:
  • Plantar medial heel pain: most noticeable with initial steps after a period of inactivity but also worse following prolonged weight bearing
  • Heel pain precipitated by a recent increase in weight-bearing activity
  • Pain with palpation of the proximal insertion of the plantar fascia
  • Positive windlass test
  • Negative tarsal tunnel tests
  • Limited active and passive talocrural joint dorsiflexion range of motion
  • Abnormal Foot Posture Index score
  • High body mass index in nonathletic individuals
(B)
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Differential Diagnosis

Clinicians should assess for diagnostic classifications other than heel pain/plantar fasciitis, including spondyloarthritis, fat-pad atrophy, and proximal plantar fibroma, when the individual's reported activity limitations or impairments of body function and structure are not consistent with those presented in the Diagnosis/Classification section of this guideline, or when the individual's symptoms are not resolving with interventions aimed at normalization of the individual's impairments of body function. (C)
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Examination - Outcome Measures

Clinicians should use the Foot and Ankle Ability Measure (FAAM), Foot Health Status Questionnaire (FHSQ), or the Foot Function Index (FFI) and may use the computer-adaptive version of the Lower Extremity Functional Scale (LEFS) as validated self-report questionnaires before and after interventions intended to alleviate the physical impairments, activity limitations, and participation restrictions associated with heel pain/plantar fasciitis. (A)
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Examination - Activity Limitation and Participation Restriction Measures

Clinicians should utilize easily reproducible performance-based measures of activity limitation and participation restriction measures to assess changes in the patient's level of function associated with heel pain/plantar fasciitis over the episode of care. (F)
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Examination - Physical Impairment Measures

When evaluating a patient with heel pain/plantar fasciitis over an episode of care, assessment of impairment of body function should include measures of pain with initial steps after a period of inactivity and pain with palpation of the proximal insertion of the plantar fascia, and may include measures of active and passive ankle dorsiflexion range of motion and body mass index in nonathletic individuals. (B)
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Interventions - Manual Therapy

Clinicians should use manual therapy, consisting of joint and soft tissue mobilization, procedures to treat relevant lower extremity joint mobility and calf flexibility deficits and to decrease pain and improve function in individuals with heel pain/plantar fasciitis. (A)
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Interventions - Stretching

Clinicians should use plantar fascia-specific and gastrocnemius/soleus stretching to provide short-term (1 week to 4 months) pain relief for individuals with heel pain/plantar fasciitis. Heel pads may be used to increase the benefits of stretching. (A)
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Interventions - Taping

Clinicians should use antipronation taping for immediate (up to 3 weeks) pain reduction and improved function for individuals with heel pain/plantar fasciitis. Additionally, clinicians may use elastic therapeutic tape applied to the gastrocnemius and plantar fascia for short-term (1 week) pain reduction. (A)
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Interventions - Foot Orthoses

Clinicians should use foot orthoses, either prefabricated or custom fabricated/fitted, to support the medial longitudinal arch and cushion the heel in individuals with heel pain/plantar fasciitis to reduce pain and improve function for short- (2 weeks) to long-term (1 year) periods, especially in those individuals who respond positively to antipronation taping techniques.

(A)
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Interventions - Night Splints

Clinicians should prescribe a 1- to 3-month program of night splints for individuals with heel pain/plantar fasciitis who consistently have pain with the first step in the morning. (A)
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Interventions - Physical Agents

Electrotherapy: clinicians should use manual therapy, stretching, and foot orthoses instead of electrotherapeutic modalities, to promote intermediate and long-term (1–6 months) improvements in clinical outcomes for individuals with heel pain/plantar fasciitis. Clinicians may or may not use iontophoresis with dexamethasone or acetic acid to provide short-term (2–4 weeks) pain relief and improved function. (D)
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Low-level laser: clinicians may use low-level laser therapy to reduce pain and activity limitations in individuals with heel pain/plantar fasciitis. (C)
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Phonophoresis: clinicians may use phonophoresis with ketoprofen gel to reduce pain in individuals with heel pain/plantar fasciitis. (C)
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Ultrasound: the use of ultrasound cannot be recommended for individuals with heel pain/plantar fasciitis. (C)
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To reduce pain in individuals with heel pain/plantar fasciitis, clinicians may prescribe:
(1) a rocker-bottom shoe construction in conjunction with a foot orthosis, and
(2) shoe rotation during the work week for those who stand for long periods.
(C)
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Interventions - Education and Counseling for Weight Loss

Clinicians may provide education and counseling on exercise strategies to gain or maintain optimal lean body mass in individuals with heel pain/plantar fasciitis. Clinicians may also refer individuals to an appropriate health care practitioner to address nutrition issues. (E)
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Interventions - Therapeutic Exercise and Neuromuscular Re-Education

Clinicians may prescribe strengthening exercises and movement training for muscles that control pronation and attenuate forces during weight-bearing activities. (F)
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Interventions - Dry Needling

The use of trigger point dry needling cannot be recommended for individuals with heel pain/plantar fasciitis. (F)
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Recommendation Grading

Disclaimer

Overview

Title

Heel Pain—Plantar Fasciitis

Authoring Organization

Publication Month/Year

October 31, 2014

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Review recent peer-reviewed literature and make recommendations related to nonarthritic heel pain.

Target Patient Population

Patients experiencing non-arthritic heel pain over the age of 16

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Operating and recovery room, Outpatient

Intended Users

Podiatrist, physical therapist, occupational therapist, nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Assessment and screening, Diagnosis, Rehabilitation, Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D036981 - Fasciitis, Plantar

Keywords

heel pain, foot pain, Plantar Fasciitis