Plantar Heel Pain Best Practice Guidelines

Updated: Jul 13


Plantar heel pain

Following the publication of the paper “Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values” by Morrissey et al I wanted to run through the take home points from the article and how this can influence your clinical practice.


Who Will Have Plantar Heel Pain?


Plantar heel pain (PHP) is most commonly found in inactive middle to older aged people. Heel pain can exist as pain that starts after rest and increases or decreases with activity. Working out which type of heel pain your patient has relies on a solid history and physical exam.


Key points to consider about Planter Heel Pain:

  • Increase in activity level

  • Increase in weight

  • Acute incident/injury

  • Other causes (inflammatory, tendinopathy, neuropathic)

  • Insidious onset

Conditions That Cause Plantar Heel Pain

Conditions that cause PHP such as plantarfasciopathy, heel bursitis (subcalcaneal bursitis), heel bumps, tarsal tunnel syndrome, chronic inflammation of the heel pad, calcaneal fracture, Sever’s disease (calcaneal apophysitis), Achilles tendinosis should all be considered during assessment.


There are a lot of studies looking at various treatment modalities but this is the first to review them all and combine them with expert opinion and patient input.


(Just as a refresher… *itis – inflammation *osis – degenerative change *opathy – change in)


The authors set out the criteria for selecting studies that included type of study, characteristics of participants, types of interventions and outcome measures. From the data collection and analysis that followed 362 studies were assessed and 51 studies met the criteria to be included.


Next the authors arranged semi-structured interviews with 14 expert clinicians from around the world. These clinicians were on average treating 9 PHP patients per month and had an average of 51 publications each.


The authors surveyed patients using an online questionnaire to explore their experiences of treatment related to PHP.


Best Approach to Plantar Heel Pain

Plantar heel pain management

From the data collected in the 3 categories the authors came up with the “Core Approach”. They recommended that all first line intervention (DO) includes plantarfascia taping and stretching as these areas provided strong evidence of effectiveness. Furthermore, the authors advise patient education (DECIDE).


It’s highlighted as a key factor for a positive outcome. The 4 categories for patient education of load management, pain education, related conditions and footwear should be discussed dependent on the patient assessment.


How Effective Is The Core Approach To Resolving Plantar Heel Pain?


As an example, load management