Introduction

Plantar fasciitis (PF) is the most common cause of chronic heel pain and is a major health issue in runners and long-distance walkers. It affects 2 million people in the USA and results in approximately 1 million visits to the physician office, 62% of which are to primary care physicians. The annual cost of treatments is estimated to be between $192 and $376 million (Tu and Bytomski, 2011). Overuse injury may lead to repetitive microtears of the plantar fascia near the calcaneus, irritating pain fibers and producing secondary inflammation. Other risk factors include obesity, flat or overarched feet and improper shoes. The pain usually involves the inferior and medial aspect of the heel (calcaneus), at the medial aspect of the calcaneal tubercle. However, the entire course of the plantar fascia may be involved. Patients typically have intense heel pain, described as aching, jabbing or burning pain, with the first couple of steps in the morning. Pain is reproduced by palpation of the median tubercle of the calcaneum and with dorsiflexion of the toes (Windlass test) (Young, 2012). In many patients, the application of ice and/or the use of heel cup orthosis activity modification and a stretching/strengthening exercise program reduce the pain satisfactorily. Further measures include deep-tissue massage therapy, night splints and periods of immobilization. Persistent problems may respond to treatment with posterior night splints, ultrasound, iontophoresis, phonophoresis, extracorporal shock wave therapy or even local corticosteroid injections (Goff and Crawford, 2011). Where medical approaches fail, surgery is advocated but has modest results. Approximately 10–12% of patients fail to achieve pain relief from medical and/or surgical treatment.