Plantar heel pain (PHP) is an umbrella term for pain on the underside of the heel that is most noticeable with weight-bearing after periods of rest—especially the first step after waking—and worsens with prolonged weight-bearing.
PHP predominantly affects sedentary middle-age and older adults. Common subgroups include people who are overweight and have a standing job, and lean runners who do too much too soon.
What is currently the best way to manage PHP based on systematic reviews, expert interviews and patient surveys?
- [Strong evidence] Start with education, plantar fascia stretching and low-dye taping—educational aspects depend on the individual patient and may include pain education, managing load, addressing related conditions (e.g., body mass index) and/or considering footwear.
- [Strong evidence] After 4‒6 weeks if the above are insufficient, then consider adding extracorporeal shockwave therapy.
- [Moderate evidence] After 12 weeks if the above are insufficient, then consider adding custom foot orthoses.
These management guidelines may need to be adjusted depending on individual circumstances.
Fascinatingly, PHP can persist for a long time with participants in this study having the condition for 13 months on average (ranging between 0.8‒68.3 months). Thus, it is important to have realistic expectations as prognosis is typically positive, but resolution is likely to be slow and may take several weeks or months.
As always, we strongly recommend a thorough assessment with a trusted health practitioner to confirm the diagnosis and to rule out serious causes, such as fractures and infections.
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- Morrissey et al. (2021) (PMID: 33785535)
- Image from InjuryMap, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons