Plantar fasciitis is a common condition that affects the deep plantar fascia, resulting in foot and heel pain. Although it is traditionally thought to be an inflammatory-driven process, histological analysis in affected patients typically shows degenerative changes. Peak incidence is between 40–60 years of age, but an earlier onset is possible, especially in people engaged in repetitive activities such as running and dancing. Other risk factors include foot deformities, prolonged weight bearing, elevated BMI, and limited ankle dorsiflexion. Plantar fasciitis is characterized by foot and/or heel pain that is typically worse first thing in the morning, then improves throughout the day before returning in the evening. Pain is usually unilateral but may be bilateral in up to a third of cases. On examination, there is tenderness to palpation at the medioplantar surface. Diagnosis is usually clinical, but imaging may be helpful in patients with atypical, severe, or persistent symptoms, or to exclude differential diagnoses (e.g., calcaneal stress fracture). Treatment is usually conservative and includes NSAIDS and activity modification. Surgery may be considered for patients with refractory pain.
Not well studied but is thought to be an overuse condition resulting in degenerative changes 
Risk factors 
Stabbing, nonradiating pain that affects the heel and sole of the foot (medioplantar surface) 
- Worse first thing in the morning or after inactivity
- Improves throughout the day
- Worsens again towards the end of the day because of prolonged weight-bearing activity
- Usually gradual onset
- May be unilateral or bilateral 
- On examination, there is tenderness at the calcaneal insertion of the plantar aponeurosis. ; 
Commonly, pain starts after a recent increase in activity. 
General principles 
- Diagnosis is usually clinical.
- Provocative tests such as the windlass test may be helpful in the diagnosis.
- Consider imaging in diagnostic uncertainty or refractory pain.
Fever, polyarthralgia, inability to bear weight, paresthesia, and/or numbness suggest differential diagnoses of plantar fasciitis and usually require further evaluation with laboratory studies and/or imaging. 
- Performing the windlass test can aid in the diagnosis of plantar fasciitis. 
- High specificity (100%) but low sensitivity (32%) for plantar fasciitis. 
- Findings are usually nonspecific; e.g:
- Skeletal 
- Neurologic 
- Soft tissue 
- Others 
The differential diagnoses listed here are not exhaustive.
Initial management, which should be offered to all patients, improves symptoms in ∼ 80% of patients by 12 months. 
Initial management 
- Reduction of biomechanical stress
- Stretching and strengthening exercises specific for the plantar fascia 
, which may include:
- Corticosteroid injections 
- Botulin toxin injections 
Treatment should be individualized to the patient's symptoms, lifestyle, and activity levels. There is no evidence for or against acupuncture or injection of autologous blood products (whole blood or platelet-rich plasma) in the treatment of plantar fasciitis; routine use is not currently recommended. 
- Indications: refractory subacute or chronic plantar fasciitis 
- Techniques 
- 3–5 sessions of low-energy treatment (anesthesia not required)
- 1 session of high-energy treatment (sedation required)