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Plantar fasciitis

40 citationsUpdated Oct 2026
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Overview

Plantar fasciitis is a common condition that may serve as a prodrome for systemic disease, which was present in 16.4% of one series [2]. The long-term prognosis is significantly worse for women and patients with bilateral pain [13]. At a mean 10 years after symptom onset, the risk of having plantar fasciitis was 45.6% [13].

Conservative management remains the initial approach, though the placebo effect in this setting is statistically and clinically significant, increases over time, and depends on the specific treatment type [6]. Home stretching protocols and physical therapy yield similar clinical outcomes [8]. Both shock-wave therapy and corticosteroids are effective for pain relief and functional improvement at 3 months [12]. For chronic cases, platelet-rich plasma (PRP) may provide greater improvements in pain and function compared to corticosteroid injections [17]. Extracorporeal shock wave therapy (ESWT) is effective, safe, and offers good long-term results [31]. Given its low complication rate, quicker recovery, and cost-effectiveness, ESWT is a reasonable earlier line of treatment before endoscopic plantar fascia release (EPF) is considered for patients refractory to nonoperative care who wish to avoid surgery [25, 18]. Multimodal rehabilitation programs effectively improve clinical outcomes and reduce plantar fascia thickness [16]. Further studies are needed to assess the utility of mDHACM within current guidelines [7].

Operative intervention is reserved for refractory cases. A randomized controlled trial demonstrated significant and clinically relevant superior results for operative treatment compared to supervised rehabilitation, measured by Foot Function Index at 1 year and VAS activity at 2 years [3]. While plantar fasciotomy remains controversial due to biomechanical arguments against surgery, long-term follow-up reports good success [4]. The endoscopic plantar fascia release technique is a standardised, reproducible procedure with good midterm results [9]. In patients resistant to ESWT, EPFR yielded good to excellent outcomes in 85% of 17 patients after 2 years [14]. Local percutaneous radiofrequency is a safe, reproducible option with good pain results for patients unresponsive to conservative treatment [1].

Anatomy & Pathophysiology

Anatomy

The plantar fascia is a fibrous aponeurosis originating from the plantar medial aspect of the calcaneal tuberosity [27]. It functions as a sheet of connective tissue spanning the foot arch from heel to toes, operating more like a ligament than a tendon [21]. Distally, the fascia divides into five slips that insert on each proximal phalanx [27]. Its fibers merge with the surrounding dermis, transverse metatarsal ligaments, and flexor tendon sheaths [27]. The structure lacks elasticity, exhibiting a maximal elongation of only 4% of its length in cadaver specimens [27]. Dorsiflexion at the first metatarsophalangeal joint activates the windlass mechanism, which increases plantar fascial tension and elevates the medial longitudinal arch [27].

The heel fat pad consists of dense fibroblastic septa arranged in a honeycomb pattern enclosing adipose tissue [11]. This pad possesses a significant neurovascular supply distinct from that of the surrounding musculature and skin [11]. The first branch of the lateral plantar nerve lies close to the plantar fascial origin and may be affected by localized tissue changes, swelling, or tethering [82].

Pathophysiology

Plantar fasciitis is characterized by pain localized to the plantar fascia insertion, exacerbated by weightbearing, especially after periods of rest [23]. Morning pain upon rising after sitting or rest is a signature symptom [21]. The condition is believed to result primarily from repetitive microtrauma and excessive strain [27]. While chronic inflammation secondary to mechanically induced microtrauma is the most widely cited mechanism for pathogenesis [23], recent studies suggest the process is noninflammatory and degenerative, more appropriately termed plantar fasciosis [27]. Histologically, the condition involves myxoid degeneration with disorientation of collagen fibers, angiofibroblastic hyperplasia, and calcification [27]. This presents as collagen degeneration and disorganization rather than significant inflammation, similar to the chronic necrosis of tendinosis [21].

Risk Factors: Reduced ankle dorsiflexion due to tightness of the Achilles tendon or gastrocnemius muscle may be associated with development [27]. Obesity and weight-bearing professions are independent risk factors [27]. Additionally, obesity and pronated foot posture are associated with chronic plantar heel pain and may be risk factors for its development [80].

Associated Findings: Bilateral involvement occurs in approximately one third of patients and should prompt consideration of inflammatory disease [27]. Plantar fasciitis can be a prodrome of systemic disease, which was present in 16.4% of a 1975 series [2]. Heel spurs are a modest calcification of the plantar fascia that are brittle and thin, and are not typically a painful mechanical problem in isolation [21]. Approximately 10-20% of the population has heel spurs, many of which are painless [21]. A heel spur seen on radiographs is most commonly considered unrelated to plantar fasciitis, although it may contribute to nerve impingement in some cases [82]. The energy-dissipating properties of the plantar fat pad are associated with the sonographic appearance of the calcaneal enthesis in symptomatic limbs [39]. Mechanical overload of the heel adipose tissue can result in fat pad atrophy, most often due to axial load trauma [11]. Chronic steroid use, either systemic or local injections, can result in adipose cell necrosis in the heel fat pad [11]. Inflammatory processes such as inflammatory arthropathy can also contribute to heel fat pad atrophy [11].

Classification

Pathological Classification: Plantar fasciitis is best classified as a degenerative process (fasciosis) rather than an inflammatory condition, characterized by collagen degeneration and disorganization with minimal inflammation [21]. While chronic inflammation secondary to mechanically induced microtrauma remains the most widely cited mechanism for pathogenesis [23], the condition fundamentally reflects a repetitive strain injury of the foot's plantar fascia structure caused by overuse standing or weight-bearing activities [21]. Mechanical overload and excessive strain within the fascia are considered fundamental to its development [23].

Other Considerations: Plantar fasciitis is the most common cause of plantar heel pain [10], a common and disabling symptom among adults aged 50 years and over [19]. Morning pain serves as a signature symptom of the condition [21]. The plantar fascia is a sheet of connective tissue spanning the arch of the foot, stretching from the heel to the toes [21]. Heel spurs represent a modest calcification of the plantar fascia and are not as much of a painful mechanical problem as often blamed [21].

Clinical Presentation

Epidemiology and Demographics

Plantar fasciitis is the most common cause of heel pain in adults, affecting 2 million persons annually in the United States [27]. Peak incidence occurs between ages 40 and 60 years, although the condition has been documented in younger runners [27]. In a general practice clinic with 10,000 patients, between 24 and 65 patients present with plantar fasciopathy each year [32]. Bilateral involvement occurs in approximately one third of patients and should prompt consideration of inflammatory disease [27].

Symptoms and Clinical Features

Morning pain is a signature symptom, with pain intensifying upon getting up after a period of sitting or rest [21]. The condition is defined as a painful heel syndrome with localized pain at the heel, worst in the morning or after resting for a long time [34]. The underlying mechanism involves chronic irritation of the arch due to excessive strain of the plantar fascia [21]. Recent studies indicate that plantar fasciitis is a noninflammatory, degenerative process more appropriately termed plantar fasciosis [27]. Histologically, it shows collagen degeneration-disorganization and little inflammation, similar to the chronic necrosis of tendinosis [21]. Bone spurs on the heel represent merely a modest calcification of the plantar fascia and are not a significant painful mechanical problem [21]. Statistically, about 10-20% of the population has heel spurs, and many individuals have painless spurs [21].

Risk Factors

Reduced ankle dorsiflexion due to tightness of either the Achilles tendon or the gastrocnemius muscle may be associated with the development of plantar fasciitis [27]. Other risk factors include advanced age and poor foot mechanics [27].

Diagnosis and Evaluation

A comprehensive history and physical examination guides accurate diagnosis [10]. Heel fat pad atrophy is a differential diagnosis usually based on history and physical examination [11]. Tenderness in heel fat pad atrophy is located in the center of the heel, more lateral and proximal than that of plantar fasciitis [11]. Prominence of the calcaneal tuberosity can indicate fat pad atrophy, which may be bilateral and/or asymmetric [11]. Standing lateral and axial views of the hindfoot should be obtained to assess for arthritis, structural abnormalities, or bony pathology in heel pain [11]. If there is no history of trauma, consider testing for systemic disease such as inflammatory arthropathy [11]. Heel pain in the elderly and patients with atypical presentations should be investigated to rule out insufficiency fractures and tumors [11].

Prognosis

The prognosis for plantar fasciitis is significantly worse for women and patients with bilateral pain [13]. Studies investigating treatment modalities for plantar fasciopathy have found treatment success in as few as 48% of participants after 6 months, and 40% still had symptoms after 2 years [32].

Investigations

History and Physical Examination: A comprehensive history and physical examination guides accurate diagnosis of plantar fasciitis [10]. Bilateral involvement occurs in approximately one third of patients and should prompt consideration of inflammatory disease [27]. If there is no history of trauma, testing for systemic disease such as inflammatory arthropathy should be considered [11]. Advanced age is a risk factor for plantar fasciitis [27].

Plain Radiography: Standing lateral and axial views of the hindfoot should be obtained to assess for arthritis, structural abnormalities, or bony pathology in heel pain evaluation [11]. Bone spurs on the heel are merely a modest calcification of the plantar fascia and are brittle and thin so that they are not as much of a painful mechanical problem [21].

MRI: MRI findings in asymptomatic professional ballet dancers may come from high loads to which dancers are exposed and may not be related to symptoms [51].

Ultrasound: Ultrasound examination was used in a 5- to 15-year follow-up study of 174 patients with plantar fasciitis [13]. Ultrasound-guided, palpation-guided, and scintigraphy-guided steroid injections were effective in the conservative treatment of plantar fasciitis [49].

Other Considerations: Prognosis for plantar fasciitis is significantly worse for women and patients with bilateral pain [13]. Chronic inflammation secondary to mechanically induced microtrauma seems to be the most widely cited mechanism for plantar fasciitis [23]. Plantar fasciitis shows collagen degeneration-disorganization and little inflammation, so it is better described as fasciosis rather than an inflammatory condition [21]. Liddle et al observed no differences between symptomatic and asymptomatic limbs with respect to the magnitude and timing of the vertical heel strike transient or first vertical force maximum in patients walking at their preferred speed [23]. Katoh et al reported a relative flattening of the typically double-humped appearance of the vertical ground reaction force profile in shod patients with plantar fasciitis walking at their preferred speed [23]. Digital loading was observed in patients with plantar fasciitis suggesting that digital function plays an important, and previously unidentified, protective role [23].

Treatment

Non-Operative

Plantar fasciitis affects 2 million persons annually in the United States, with peak incidence occurring between ages 40 and 60 years [27]. Bilateral involvement occurs in approximately one third of patients [27]. Conservative management options include taping, which demonstrates a standardized mean difference of 0.47 (95% CI 0.05 to 0.88) for first-step pain in the short term [74]. Plantar fascia stretching shows a standardized mean difference of 1.21 (95% CI 0.78 to 1.63) for first-step pain in the short term [74]. Stepped care management with focused shockwave is recommended for first-step pain in the short term with an odds ratio of 1.89 (95% CI 1.18 to 3.04), the medium term with a standardized mean difference of 1.31 (95% CI 0.61 to 2.01), and the long term with a standardized mean difference of 1.67 (95% CI 0.88 to 2.45) [74]. Radial shockwave is recommended for first-step pain in the short term with an odds ratio of 1.66 (95% CI 1.00 to 2.76) and in the long term with an odds ratio of 1.78 [74].

Shock-wave therapy appears to be a better alternative than ultrasound due to higher improvement in VAS scores [36]. Radial extracorporeal shock wave therapy significantly improves pain, function, and quality of life compared with placebo in patients with recalcitrant plantar fasciitis [37]. The application of electrohydraulic high-energy shock waves to the heel is a safe and effective noninvasive method to treat chronic plantar fasciitis, lasting up to and beyond one year [20]. Three treatments with 1000 impulses of low-energy shock waves appear to be an effective therapy for plantar fasciitis and may help the patient to avoid surgery for recalcitrant heel pain [76]. However, a regime of moderate dose ESWT has no significant treatment effect in patients with chronic plantar fasciitis compared to placebo [24]. There is likely a role for extracorporeal shock wave therapy in patients with chronic plantar fasciitis refractory to nonoperative treatment who would prefer to avoid surgery [25]. Both corticosteroid and PRP injections were effective and successful in treating plantar fasciitis [71].

Prognosis data indicate that the risk of having plantar fasciitis was 45.6% at a mean 10 years after the onset of symptoms, with a significantly worse prognosis for women and patients with bilateral pain [13]. Treatment success in as few as 48% of participants was found after 6 months, and 40% still had symptoms after 2 years [32].

Operative

Indications: Inclusion criteria for endoscopic debridement, ostectomy, release, and radiofrequency include patients with at least 6 months of recalcitrant heel pain refractory to conservative measures such as activity alteration, footwear modifications, plantar fascia-specific stretching exercises, and analgesics [73].

Surgical Approach / Technique: Endoscopic fasciotomy for plantar fasciitis provides superior results when compared to a controlled non-operative treatment protocol as measured by Foot Function Index at 1 year and by VAS activity at 2-year follow-up [3]. The symptoms of pain and limb function were significantly improved in patients both of the partial plantar fascia release treated group and the percutaneous radiofrequency ablation treated group [40].

Complications

Adipose Tissue Injury: Chronic steroid use, whether systemic or local injections, can result in adipose cell necrosis [11]. Mechanical overload of the heel adipose tissue can result in atrophy, most often due to axial load trauma [11].

Management Considerations: There is no role for surgical treatment of isolated fat pad atrophy [11]. Steroid injections into adipose tissue should be avoided [11].

Recovery

The provided evidence base does not contain specific data regarding recovery timelines, rehabilitation protocols, or functional milestones for plantar fasciitis. Consequently, the standard recovery phases (Light activity, Full activity, Complete recovery) and specific rehabilitation protocols cannot be defined from this text. The available data pertains to treatment outcomes and prognostic factors rather than temporal recovery trajectories.

Other Considerations: Customized or prefabricated orthoses improve function in the short term [22]. In chronic plantar fasciitis, platelet-rich plasma (PRP) may lead to greater improvement in pain and functional outcome over corticosteroid injections [17]. Further studies are needed to assess the utility of micronized dehydrated amniotic/chorionic membrane allograft (mDHACM) within current treatment guidelines [7]. Endoscopic plantar fascia release (EPFR) yielded good to excellent outcomes in 85% of 17 patients with plantar fasciitis resistant to extracorporeal shock wave therapy (ESWT) after 2 years' follow-up [14]. Patients who experienced temporary improvement after local corticosteroid injection had better clinical outcomes following endoscopic plantar fascia release [33].

Key Evidence

  • [Paper] It is a safe and reproducible treatment option with good results in terms of pain for patients with plantar fasciitis and no response after conservative treatment. [1] (10.1016/j.eats.2021.01.031)
  • [L4] Plantar fasciitis can be a prodrome of systemic disease, which was present in 16.4% of the series. [2] (10.2106/00004623-197557050-00016)
  • [L1] This randomized controlled trial found significant and clinically relevant superior results for the operative treatment of plantar fasciitis as measured by Foot Function Index at 1 year and by VAS activity at 2-year follow-up when compared to the results of a supervised rehabilitation program. [3] (10.1007/s00167-020-05855-3)
  • [L4] Plantar fasciotomy surgery for plantar fasciitis remains controversial, with biomechanical arguments against surgery; however, this article reports good success following surgery over a long follow-up period. [4] (10.1177/2325967114527901)
  • [L1] This effect is statistically and clinically significant, increases over time, and depends on the type of conservative treatment applied to address plantar fasciitis. [6] (10.1530/eor-23-0082)
  • [L1] Further studies are needed to better assess the utility of mDHACM within current treatment guidelines for the management of plantar fasciitis. [7] (10.1177/1071100713502179)
  • [L1] The clinical outcomes of a home stretching protocol and physical therapy did not markedly differ for the treatment of plantar fasciitis. [8] (10.5435/jaaos-d-21-00009)
  • [L4] The endoscopic plantar fascia release technique can be performed as a standardised and reproducible procedure with good midterm results. [9] (10.1007/s00167-004-0496-6)
  • [L5] Plantar fasciitis is the most common cause of plantar heel pain, and a comprehensive history and physical examination guide accurate diagnosis. [10] (10.5435/00124635-200806000-00006)
  • [L1] Both shock-wave therapy and corticosteroids were effective and successful in relieving pain and improving self-reported function in the treatment of plantar fasciitis at 3 months. [12] (10.1007/s00402-018-3071-1)
  • [L3] The risk of having plantar fasciitis was 45.6% at a mean 10 years after the onset of symptoms, with a significantly worse prognosis for women and patients with bilateral pain. [13] (10.1177/2325967118757983)
  • [L4] EPFR yielded good to excellent outcomes in 85% of 17 patients with plantar fasciitis resistant to treatment by ESWT after 2 years' follow-up. [14] (10.1016/j.arthro.2010.01.026)
  • [L2] Both programs effectively improved clinical outcomes and reduced plantar fascia thickness in patients with PF. [16] (10.1186/s12891-026-09562-x)
  • [L1] In patients with chronic plantar fasciitis, the current clinical evidence suggests that PRP may lead to a greater improvement in pain and functional outcome over CS injections. [17] (10.1177/2325967120915704)
  • [L3] ESWT is a reasonable earlier line of treatment of chronic plantar fasciitis before EPF is tried. [18] (10.1007/s00402-009-1034-2)
  • [L3] Plantar heel pain is a common, disabling symptom among adults aged 50 years and over. [19] (10.1186/s12891-019-2718-6)
  • [L1] The application of electrohydraulic high-energy shock waves to the heel is a safe and effective noninvasive method to treat chronic plantar fasciitis, lasting up to and beyond one year. [20] (10.2106/00004623-200410000-00013)
  • [L5] [21] (10.1177/2325967124s00374)
  • [L1] In patients with plantar fasciitis, customized orthoses or prefabricated orthoses improved function in the short term. [22] (10.2106/jbjs.8902.ebo2)
  • [L3] [23] (10.1097/01.blo.0000057989.41099.d8)
  • [L1] [24] (10.1016/s0736-0266(03)00048-2)
  • [L1] Given the low complication rate, potentially quicker recovery time, and potential cost-effectiveness, there is likely a role for extracorporeal shock wave therapy in patients with chronic plantar fasciitis refractory to nonoperative treatment who would prefer to avoid surgery. [25] (10.2106/jbjs.o.00192)
  • [L5] [27] (10.5435/jaaos-22-06-372)
  • [L1] Extracorporeal shockwave treatment is effective and safe for patients with plantar fasciitis, with good long-term results. [31] (10.1177/0363546505281811)
  • [L1] [32] (10.1136/bjsports-2023-106948)
  • [L3] Patients who experienced temporary improvement after local corticosteroid injection had better clinical outcomes following endoscopic plantar fascia release. [33] (10.1186/s12891-025-08816-4)
  • [L4] [34] (10.1186/s13018-023-04202-9)
  • [L1] Both SWT and UT are effective in relieving pain and improving self-reported function in the treatment of plantar fasciitis, but SWT appears to be a better alternative due to higher improvement in VAS scores. [36] (10.1007/s00402-019-03262-z)
  • [L1] Radial extracorporeal shock wave therapy significantly improves pain, function, and quality of life compared with placebo in patients with recalcitrant plantar fasciitis. [37] (10.1177/0363546508324176)
  • [L3] The energy-dissipating properties of the plantar fat pad are associated with the sonographic appearance of the calcaneal enthesis in symptomatic limbs, providing a previously unidentified link between the mechanical behavior of the plantar fat pad and enthesopathy. [39] (10.1177/0363546510377405)
  • [L4] The symptoms of pain and limb function were significantly improved in patients both of the partial plantar fascia release treated group and the percutaneous radiofrequency ablation treated group. [40] (10.1186/s13018-020-1582-2)
  • [L2] Ultrasound-guided, palpation-guided, and scintigraphy-guided injections were effective in the conservative treatment of plantar fasciitis. [49] (10.1007/s00402-008-0760-1)
  • [L4] Those findings may come from high loads to which dancers are exposed and may not be related to symptoms. [51] (10.1016/j.jisako.2023.03.025)
  • [L1] Both corticosteroid and PRP injections were effective and successful in treating plantar fasciitis. [71] (10.1007/s00402-012-1488-5)
  • [Paper] [73] (10.1016/j.eats.2024.103150)
  • [L1] [74] (10.1136/bjsports-2019-101970)
  • [L1] Three treatments with 1000 impulses of low-energy shock waves appear to be an effective therapy for plantar fasciitis and may help the patient to avoid surgery for recalcitrant heel pain. [76] (10.2106/00004623-200203000-00001)
  • [L3] Obesity and pronated foot posture are associated with chronic plantar heel pain and may be risk factors for the development of the condition. [80] (10.1186/1471-2474-8-41)
  • [L5] [82] (10.5435/00124635-199703000-00006)

References

[1] Local Percutaneous Radiofrequency for Chronic Plantar Fasciitis. Arthroscopy Techniques. 2021. DOI: 10.1016/j.eats.2021.01.031

[2] Plantar fasciitis. The painful heel syndrome. The Journal of Bone & Joint Surgery. 1975. DOI: 10.2106/00004623-197557050-00016

[3] Endoscopic fasciotomy for plantar fasciitis provides superior results when compared to a controlled non-operative treatment protocol: a randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-05855-3

[4] Surgery for Patients With Recalcitrant Plantar Fasciitis. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114527901

[6] The ‘placebo effect’ in the conservative treatment of plantar fasciitis: a systematic review and meta-analysis. EFORT Open Reviews. 2023. DOI: 10.1530/eor-23-0082

[7] Prospective, Randomized, Blinded, Comparative Study of Injectable Micronized Dehydrated Amniotic/Chorionic Membrane Allograft for Plantar Fasciitis—A Feasibility Study. Foot & Ankle International. 2013. DOI: 10.1177/1071100713502179

[8] A Prospective Randomized Controlled Trial Comparing Physical Therapy With Independent Home Stretching for Plantar Fasciitis. Journal of the American Academy of Orthopaedic Surgeons. 2022. DOI: 10.5435/jaaos-d-21-00009

[9] Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (E FRPF). Knee Surgery, Sports Traumatology, Arthroscopy. 2004. DOI: 10.1007/s00167-004-0496-6

[10] Plantar Fasciitis: Evaluation and Treatment. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200806000-00006

[11] Chapter 116 Heel Pain. 2019.

[12] Comparison of efficacy of shock-wave therapy versus corticosteroids in plantar fasciitis: a meta-analysis of randomized controlled trials. Archives of Orthopaedic and Trauma Surgery. 2018. DOI: 10.1007/s00402-018-3071-1

[13] Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118757983

[14] Endoscopic Plantar Fascia Release by Hooked Soft‐Tissue Electrode After Failed Shock Wave Therapy. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2010.01.026

[16] The effect of multimodal rehabilitation program on pain, functional outcomes, and plantar fascia thickness in patients with plantar fasciitis: a randomized controlled trial. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09562-x

[17] Platelet-Rich Plasma Versus Corticosteroids for Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120915704

[18] Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis. Archives of Orthopaedic and Trauma Surgery. 2009. DOI: 10.1007/s00402-009-1034-2

[19] Plantar heel pain in middle-aged and older adults: population prevalence, associations with health status and lifestyle factors, and frequency of healthcare use. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2718-6

[20] Electrohydraulic High-Energy Shock-Wave Treatment for Chronic Plantar Fasciitis. The Journal of Bone & Joint Surgery. 2004. DOI: 10.2106/00004623-200410000-00013

[21] Controversies of the Plantar Fasciitis. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/2325967124s00374

[22] Customized or Prefabricated Foot Orthoses Improved Function Only in the Short Term in Patients with Plantar Fasciitis. The Journal of Bone & Joint Surgery. 2007. DOI: 10.2106/jbjs.8902.ebo2

[23] The Effect of Plantar Fasciitis on Vertical Foot-Ground Reaction Force. Clinical Orthopaedics and Related Research. 2003. DOI: 10.1097/01.blo.0000057989.41099.d8

[24] Extracorporeal shock wave therapy for plantar fasciitis. A double blind randomised controlled trial. Journal of Orthopaedic Research. 2003. DOI: 10.1016/s0736-0266(03)00048-2

[25] Is Extracorporeal Shock Wave Therapy an Underutilized Treatment for Chronic Plantar Fasciitis?. The Journal of Bone and Joint Surgery-American Volume. 2015. DOI: 10.2106/jbjs.o.00192

[27] Plantar and Medial Heel Pain. Journal of the American Academy of Orthopaedic Surgeons. 2014. DOI: 10.5435/jaaos-22-06-372

[31] Long-term Results of Extracorporeal Shockwave Treatment for Plantar Fasciitis. The American Journal of Sports Medicine. 2006. DOI: 10.1177/0363546505281811

[32] Does a corticosteroid injection plus exercise or exercise alone add to the effect of patient advice and a heel cup for patients with plantar fasciopathy? A randomised clinical trial. British Journal of Sports Medicine. 2023. DOI: 10.1136/bjsports-2023-106948

[33] Does local steroid injection have a prognostic value for endoscopic plantar fascia release in chronic plantar fasciopathy?. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08816-4

[34] Arabic translation, cross cultural adaptation, and validation of Foot Health Status Questionnaire among Saudi individuals with plantar fasciitis. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04202-9

[36] Shock-wave therapy improved outcome with plantar fasciitis: a meta-analysis of randomized controlled trials. Archives of Orthopaedic and Trauma Surgery. 2019. DOI: 10.1007/s00402-019-03262-z

[37] Radial Extracorporeal Shock Wave Therapy is Safe and Effective in the Treatment of Chronic Recalcitrant Plantar Fasciitis. The American Journal of Sports Medicine. 2008. DOI: 10.1177/0363546508324176

[39] Plantar Enthesopathy. The American Journal of Sports Medicine. 2010. DOI: 10.1177/0363546510377405

[40] Comparison of the therapeutic outcomes between open plantar fascia release and percutaneous radiofrequency ablation in the treatment of intractable plantar fasciitis. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-1582-2

[49] Comparison of ultrasound-, palpation-, and scintigraphy-guided steroid injections in the treatment of plantar fasciitis. Archives of Orthopaedic and Trauma Surgery. 2008. DOI: 10.1007/s00402-008-0760-1

[51] MRI Findings of the Foot and Ankle in Asymptomatic Professional Ballet Dancers. Journal of ISAKOS. 2023. DOI: 10.1016/j.jisako.2023.03.025

[71] The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis. Archives of Orthopaedic and Trauma Surgery. 2012. DOI: 10.1007/s00402-012-1488-5

[73] Endoscopic Debridement, Ostectomy, Release, and Radiofrequency: A Fully Endoscopic Technique for Treating Recalcitrant Plantar Fasciitis. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103150

[74] Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. British Journal of Sports Medicine. 2021. DOI: 10.1136/bjsports-2019-101970

[76] EVALUATION OF LOW-ENERGY EXTRACORPOREAL SHOCK-WAVE APPLICATION FOR TREATMENT OF CHRONIC PLANTAR FASCIITIS. The Journal of Bone and Joint Surgery-American Volume. 2002. DOI: 10.2106/00004623-200203000-00001

[80] Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched case-control study. BMC Musculoskeletal Disorders. 2007. DOI: 10.1186/1471-2474-8-41

[82] Plantar Fasciitis: Diagnosis and Conservative Management. Journal of the American Academy of Orthopaedic Surgeons. 1997. DOI: 10.5435/00124635-199703000-00006

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Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.