The American College of Foot and Ankle Surgeons has recently released an updated Clinical Consensus Statement regarding the Diagnosis and Treatment of Adult Acquired Heel Pain (Plantar Fasciitis).

Heel pain or plantar fasciitis is a very common pathology seen in our foot and ankle practice. A literature review and expert panel discussion of the most common findings and treatment options were presented in this document. Various diagnostic and treatment modalities are available to our Podiatrists. Our approach is to combine appropriate history and physical examination findings with these treatment modalities for optimum success in managing heel pain. The most common diagnostic tools and treatment options were presented in this statement, along with a discussion of the appropriateness of each treatment based on the published data and experience of the expert panel.

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 xrays is not necessary for the diagnosis of plantar fasciitis.
3. The presence of a calcaneal spur will not generally alter the treatment course.
4. Advanced imaging, such as MRI and ultrasound, is not necessary for the diagnosis or guidance of treatment for plantar fasciitis.
5. In most cases, plantar heel pain is a soft tissue-based disorder and heel 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 surgical option for chronic plantar fasciitis that has not responded to any other treatment.

While we would not necessarily agree entirely with all of the findings from the panel, this statement provides a nice summary of the current thinking relating to heel pain and plantar fasciitis treatments.