Heel pain

Last evidence check March 2011

Plantar fasciitis is the commonest cause of heel pain. We see about 50 new patients per year in a population of 260,000 or 193/million/year. However, this is only the tip of the iceberg as many people probably never consult a practitioner about this condition, or are treated by a GP, podiatrist, rheumatologist or sports medicine practitioner.

Most series looking at a general population have a mean age in the late 50s. The mean age in series concentrating on athletes is about 10 years younger. The condition is rarely seen under the age of 20 or in extreme old age. Male:female ratio is about 1:2. It is commoner in the obese, in those standing for prolonged periods at work and working on a hard surface (Gill et al 1996, Riddle 2003).

Plantar fasciitis is often said to be commoner in overpronators, but most studies which have looked have found a large majority have neutral feet. As the incidence of overpronation in the general population is unknown this is impossible to interpret. Even in athletes Kibler et al (1991) found only 10/43 with overpronation. However Prichasuk (1994) found mean calcaneal pitch to be significantly lower (16º versus 20.5º) in patients with symptomatic heel pain than in normal feet, and Huang et al (2004) found ultrasonographic changes in 43% of people with flatfoot but 9% in those with normal arches. All of these studies have potential for selection bias.

Riddle et al (2004) found that plantar fasciitis mainly affected work, hobbies and running rather than non-weightbearing and light physical activities. Obesity was the main predictor of the degree of disability.

Most patients can be manaaged with a rehabilitation approach. Explanation, stretching exercises, orthotics in the presence of biomechanical abnormality and simple pain management are the main features of treatment. A small group of patients display significant chronic pain features and an early pain management approach may be helpful; however, there are no published studies of this group.