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Plantar Heel Pain

This tool provides information to facilitate the management of plantar heel pain in adults.

Plantar heel pain is associated with impaired health-related quality of life including social isolation, a poor perception of health status and reduced functional capabilities.

Focused examination

1. Patient History 

  • Assess level of concern for major structural or other pathologies. If required, refer to an appropriate healthcare provider

  • Identify and assess other conditions and co-morbidities. Manage using appropriate care pathways

  • Understand the patient’s beliefs and expectations about plantar heel pain

Major structural or other pathologies may be suspected with certain signs and symptoms (red flags):

  • Positive Ottawa Ankle Rules, children <12 years of age, elderly patients, erythema, warmth, fever, chills, prolonged pain, swelling, catching and/or instability of the ankle joint, pain at rest, awakening due to pain at night, bilateral pain

Examples of other conditions/co-morbidities:

  • Physical conditions: patellofemoral pain, lumbar strain

  • Psychological conditions: depression, anxiety

  • Co-morbidities: diabetes (peripheral neuropathy), chronic venous insufficiency

2. Physical Examination

  • Assess levels of concern regarding major structural or other pathologies

  • Assess for differential diagnoses (i.e., tarsal tunnel syndrome, stress fracture, Achilles tendinitis, retrocalcaneal bursitis)

  • Identify patient's baseline status relative to pain, function and disability, determine the patient's readiness to return to activities using appropriate assessments

3. Management 

  • Offer individualized education in conjunction with low dye taping and plantar fascia stretching

  • Discuss the range of effective interventions with the patient and, together, select a therapeutic intervention

  • Utilize a stepped care approach for patients progressing slowly or inadequately

4. Reevaluation and discharge

  • Reassess the patient at every visit to determine if: (1) additional care is necessary; (2) the condition is worsening; or (3) the patient has recovered

  • Monitor for any emerging factors that may delay recovery

Anchor 1

Therapeutic Recommendations 

  • Provide a core approach of plantar fascia stretching, taping to support the plantar fascia, and individualized education. 

Individualized education¹ may include:

  • Load management to break up long periods of static loading or rapid training changes in more athletic populations

  • Pain education

  • Address related conditions (i.e., Type 2 diabetes)

  • Footwear advice to ensure comfort in shoes that allow rearfoot to forefoot (RF/FF) drop while also considering social acceptability to improve adherence

Consider dry needling as an adjunct intervention to the core approach²

Consider extracorporeal shockwave therapy (focused or radial) for people with non-resolving, persistent symptoms (at 4 weeks)

Consider custom foot orthoses if patients do not respond to core approach or shockwave therapy (at 12 weeks)


¹The educational delivery should adopt a realistic tone as recovery may take several weeks or months but is important to stress the positive prognosis.

²Dry needling should not be a first-line treatment but may be considered to influence pain and muscle tension when combined with other interventions

Care Pathway for the management of plantar heel pain

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