Plantar Heel Pain
NHS Tayside RefGuide
Warning
Who to refer
If no improvement after 3 months conservative management.
How to refer
SCI Gateway/Orthopaedics/Foot and Ankle Service.
Referral will be vetted by AHP and directed to most appropriate professional (most likely AHP in first instance for assessment).
Symptoms and signs
- 80% self-limiting and resolve with simple self-treatment
- Gradual onset with stiffness rising in the morning is typical of Achilles and plantar heel pain
- Usually worse on initial weight bearing in the morning, better throughout the day and increasing in the evening.
- Electric shock pain, reduced sensation or pain at rest indicate possible nerve entrapment or lumbar spine referral
- Tenderness at attachment of PF to medial calcaneal tubercle
- Fat pad atrophy with non-specific pain under heel.
Initial management
- Provide with patient information leaflet for plantar fasciitis to aid self-management.
- Imaging is not indicated. No merit in XR to look for heel spur, the finding of a spur has no bearing on treatment
- Analgesia & NSAIDs as appropriate.
- Advise weight loss if appropriate
- Heel cushions
- Regular calf/ plantar fascia stretching
- Off the shelf In shoe orthosis (From Boots/Allardyce/PhysioMed)
- Consider steroid injection if skilled to do so.
Useful resources
- NHS Tayside Patient Leaflet - Plantar Fasciitis (includes general advice, footwear recommendations and exercises)
- NICE CKS Plantar Fasciitis info Includes summary management advice and links to exercises.