Snapshot A 45-year-old woman presents to the physician’s office for foot pain. She reports that this pain has been going on for 6 months now. The pain is worse in the morning or after a nap and improves with walking. As a marathon runner, she is worried that her daily running has caused this condition. She is counseled and reassured that no surgery is needed. Introduction Clinical definition degenerative condition of the plantar fascia that causes sharp pain on the bottom of the foot pain Epidemiology Demographics female > male 40-60 years of age older and obese patients Location plantar fascia originates at the calcaneal tubercle Risk factors obesity flat feet (pes planus) overpronation of the foot prolonged walking or running Etiology May be due to bony spur but often the etiology is unknown Pathogenesis repetitive microtrauma from prolonged use of foot causes tensile overload and damage to the plantar fascia Associated conditions Achilles tendinopathy Presentation Symptoms sharp heel pain, like a tack in the foot pain is worse with first step in the morning or after a period of rest, then improves with walking may be worse again at the end of the day with prolonged weight-bearing may also improve with stretching, massage, and rest Physical exam tenderness to palpation at the underside of the heel, at the insertion of the plantar fascia positive windlass test pain elicited when the clinician dorsiflexes the hallux and stretches the plantar fascia Imaging Radiography indication typically not indicated unless the diagnosis is unclear findings may have a bony spur at the location of the pain Differential Tarsal tunnel syndrome distinguishing factors presents with pain or numbness along the plantar surface of the foot that is worsened by tapping the tarsal tunnel in comparison with plantar fasciitis, pain does not get better with rest and rather may be the worst at night DIAGNOSIS Making the diagnosis most cases are clinically diagnosed Treatment Conservative stretching of the foot and calf indication for all patients orthotics or night splinting indication for all patients Medical nonsteroidal anti-inflammatory drugs (NSAIDs) indication pain management steroid injection indication pain management refractory to NSAIDs Complications None Prognosis Typically resolves spontaneously in 1-2 years