Plantar Fasciopathy

Plantar fasciopathy is the most common cause of plantar heel pain. Featuring pain and tenderness on the medial plantar aspect of the calcaneus, clinical diagnosis seems straightforward. The role of various management strategies should be considered in the light of the selflimiting nature of plantar fasciopathy with more than 80% of patients experiencing resolution within 12 months, regardless of management. As there are no data from high-quality, randomized, controlled trials that support the efficacy of surgical management, the most prudent approach is to employ conservative modalities first. Recently, several randomized, controlled trials proved efficacy of extracorporeal shockwave treatment after the failure of more common conservative methods. Shockwave treatment helped to avoid surgery and its associated risks such as transient swelling of the heel pad, calcaneal fracture, injury of the posterior tibial nerve or its branches, and flattening of the longitudinal arch with resultant midtarsal pain. Surgical treatment is therefore considered in only a small subset of patients with persistent, severe symptoms refractory to nonsurgical intervention for at least 6 to 12 months.