Table 1.

Risk factors, Diagnosis and Treatment Recommendations for People with Plantar Heel Pain.

	Non-athletic population	Athletic population
Risk factors	•Foot shape (pes planus/pes cavus)65 •High BMI18,66 •Prolonged standing/walking18 •Sedentary lifestyle65 •Achilles tendon tightness65	•Thought to be from: •Excessive running65 •Overuse65 •Inappropriate footwear18,66
Diagnosis
Clinical	•Patient history18 •Palpation of medial plantar heel and plantar fascia18 •Pain on rising after periods of rest18	•Patient history18 •Palpation of medial plantar heel, enthesis and plantar fascia18 •Pain on rising after periods of rest18 •Pain after running65
Imaging	Ultrasonography •PF thickness >4 mm65 •>1 mm difference in PF thickness between symptomatic and asymptomatic heels16 •Areas of hypoechogenicity65 MRI •PF thickness15 •Signal change in the PF67 •Soft tissue oedema and bone marrow oedema at the PF calcaneal attachment67 Plain film radiographs •Bone pathology (e.g.) calcaneal heel spurs15	•Limited research. Assumed to be as per non-athletic population
Treatment	Acute/Chronic Based on VAS and PROM outcome measures for pain •Custom orthoses18 (S) •Calf stretching18 (M) •Taping18 (M) •Footwear18 •Corticosteroid injections18 •NSAIDs66 Recalcitrant •ECSWT66 (MS) •Surgery – fasciotomy/nerve release19,66	•Limited research. Assumed to be as per non-athletic population

Athlete A person training to improve performance for competitive advantage,⁸BMI Body mass index, PF Plantar fascia, MRI Magnetic resonance imaging, ECSWT Extracorporeal shock wave therapy, VAS Visual analogue scale, PROM Patient-reported outcome measure. NSAIDs Non-steroidal anti-inflammatory drugs, S Strong evidence for short-term outcomes, M Moderate evidence for short-term outcomes, MS Moderate-strong evidence for short-term outcomes.

NB Strength of recommendations are based on a system developed by Morrissey et al.¹⁸