Consensus statement on plantar heel pain

Amongst the important statements are the following. Keep in mind that this is opinion based and therefore a low level of evidence.

The panel determined that the following statements are appropriate:

1. Plantar fasciitis is diagnosed, in most cases, by the history and physical examination findings alone.
2. Routine use of radiographs is not necessary for the diagnosis of nontraumatic plantar fasciitis.
3. The presence of a calcaneal spur will not generally alter the treatment course.
4. Advanced imaging, such as magnetic resonance imaging and ultrasonography, is not necessary for the diagnosis or guidance of treatment of nontraumatic plantar fasciitis.
5. In most cases, infracalcaneal heel pain is a soft tissue-based disorder and calcaneal spurring is most likely not a causative factor.
6. Appropriate treatment of plantar fasciitis requires sufficient understanding of the patient's chronicity of symptoms.
7. Biomechanical support is safe and effective in the treatment of plantar fasciitis.
8. Stretching is safe and effective in the treatment of plantar fasciitis.
9. Corticosteroid injections are safe and effective in the treatment of plantar fasciitis.
10. Extracorporeal shockwave therapy (ESWT) is safe and effective in the treatment of plantar fasciitis.
11. Plantar fasciotomy (opened and endoscopic) is a safe and effective option for chronic, refractory plantar fasciitis.
12. Gastrocnemius release is a safe and effective option for chronic, refractory plantar fasciitis when clinically significant equinus is present.

Nothing too much jumping out at me here and the recommendations seem sensible. I remain dubious about the efficacy of CS infiltration and there is little doubt there are significant risks associated with this treatment.

The full paper with all recommendations, and some things NOT reccommended may be read here: diagnosis and treatment of adult acquired infracalcaneal heel pain.pdf

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Simon Bartold
Director of Bartold Clinical

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