Plantar heel pain

What you need to knowA 56 year old retail manager complains of four months of pain under her left heel. It is worse first thing in the morning and after sitting.About one in 10 people aged over 50 years report plantar heel pain.1 A recent ultrasound study of 175 feet with plantar heel pain in a secondary care population diagnosed plantar fasciitis in 73% of cases.2 The symptoms above are typical. Take a historyAsk the patient where the pain is and what it feels like. Patients with plantar fasciitis typically describe a sharp pain under the heel. It may extend along the arch of the foot, from the insertion, along the length of the plantar fascia. Pain is worse when taking their initial steps in the morning and eases after a few minutes of walking, but it may return on weight bearing after periods of inactivity during the day. Symptoms are bilateral in about a third of cases.3Explore alternative diagnoses. Trauma from landing on the heel from height can fracture the calcaneum, for example. Previous surgery to the area could lead to longstanding heel pain of iatrogenic causes. If there is pain elsewhere in the body, …