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1 Plantar fasciitis (PF) is felt to be on the increase, although the exact incidence is unknown.

2 Look for the main symptoms of heel pain on walking and tenderness when palpating and stretching the sole of the foot.

3 An accepted cause is over-pronation (flat feet)

4 The first element to treatment is identifying and correcting any possible cause. Advise patients to wear soft shoes, avoid running on hard or uneven surfaces, ensure adequate arch support and lose excess weight.

5 Regular stretching exercises are imperative.

I usually advise the patient to roll a towel up and flip it over the ball of their foot and then gradually lift and maintain a stretch. Persistence with daily stretches usually results in excellent symptom resolution.

6 If you find the patient has tender muscular spasm or 'trigger points' in their gastrocnemius or calf muscle, then treating these can often relieve plantar pain.

7 Only refer to an orthopaedic specialist if treatment has failed over nine to 12 months or if the symptoms are severe. It is rare that patients require surgery or cortisone injections. Growing consensus among specialists is that patients are best treated non-surgically and that the majority of patients will be asymptomatic after nine to 12 months of conservative therapy.

8 Cortisone injections seem to benefit some patients but can be painful and carry all the standard risks associated with an invasive procedure. There is also concern that they may be associated with an increased risk of rupture of the plantar fascia and there is a general feeling that these injections only carry a shortlived benefit, if at all. I personally no longer inject the plantar fascia unless there is a compelling reason to do so.

9 There remains debate regarding the role of NSAIDs. Although it would seem logical that these would help and they are obviously regularly prescribed, to date there has never

been a validated randomised trial on their benefit.

10 The best way to prevent recurrent PF is well-fitting shoes with arch support if appropriate.

Other measures include stretching prior to exercise, avoiding jarring to the heel and keeping an optimal weight.

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