Best practice guidelines for plantar heel pain

Plantar heel pain usually affects middle-aged and older adults who are sedentary, but also accounts for 8% of all running-related injuries. Patients often describe pain on the first steps of walking, during weight-bearing activities, and particularly during periods of rest. This condition can have severe effects on the physical and mental wellbeing of patients.

High-quality randomised controlled trials were scrutinised to offer the best guidance for managing plantar heel pain. It was revealed that best practice should involve:-

# stretching

# foot taping

# educational interventions for footwear, activity modifications and fear avoidance techniques. Recovery may take several weeks or months, and this information must be conveyed to the patient.

Should this approach fail, then it is recommended patients undergo a course of Extracorporeal Shockwave Therapy (ESWT). This method of treatment has shown to have positive short, medium and long term benefits.

Should these approaches fail, then there is evidence that the following may help:-

# dry needling

# corticosteroid and platelet-rich plasma

# resistance exercises

A key piece of evidence, which is crucial to patient management and recovery, is education. It is so important that the following is communicated clearly:-

# the underlying pathology

# causal factors

# efficacy of various treatments

# mechanisms behind interventions

# knowledge regarding expectations

# alternative plans should treatment fail