A Quick Synopsis of AFP's "Diagnosis and Treatment of Plantar Fasciitis"

A Quick Synopsis of AFP's;
Diagnosis and Treatment of Plantar Fasciitis
JAMES D. GOFF, DO, and ROBERT CRAWFORD, MD, Summa Health System, Akron, Ohio
http://www.aafp.org/afp/2011/0915/p676.pdf
Am Fam Physician. 2011 Sep 15;84(6):676-682

     Plantar fasciitis is an injury, causing sharp pain on the bottom of the heal. It is a sports injury from overuse, running, or prolonged standing. Patients will complain of heel pain after standing up out of bed in the morning, or after prolonged sitting. Walking barefoot may also reproduce the pain. Sharp pain will be observed on the medial aspect of the heel during palpation.  Dorsiflexion of the first toe will also reproduce the pain. Imaging, although unnecessary (unless used to rule out other causes in the differential) will show a heel spur or a thickened plantar fascia. Risk factors include excessive foot pronation, flat feet, obesity, high arch, tight achilles tendon, sedentary lifestyle, and a job the requires prolonged standing or walking. 
     Regardless of treatment, plantar fasciitis should improve within a year. Initial treatment should include rest, activity modification, ice massage  stretching, NSAIDs, acetaminophen  and weight loss. In addition, patients may find relief with heel cups, orthotics, or anterior night splints, all of which can be found over the counter. 
     If the conservative therapy is ineffective, other therapies, such as eccentric stretching, deep myofascial massage, iontophoresis (using electricity to increase absorption of charged topical medicine through the skin), or steroid injections. Extracorporeal shock wave therapy, which is supposed to increase blood flow and healing, has had mixed results. Plantar fasciotomy is a last line therapy which has been effective, but is invasive.  These last two choices are typically reserved for chronic recalcitrant fasciitis, lasting six months or longer.