Plantar heel pain.

Ask 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. Explore 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, other symptoms, or systemic upset, consider inflammatory arthropathy. In such cases, the heel stiffness may be prolonged >30 minutes in the morning. There may be night pain or prolonged pain when weight bearing has ceased. Bilateral symptoms are common. Ask whether other joints are affected. Suspect malignancy in those with unremitting pain, weight loss, or a history of cancer. In those with muscle weakness, sensory symptoms, or accompanying leg or back pain, suspect a neurological problem causing referred pain to the foot, such as lumbar spine radiculopathy, nerve entrapment, or tarsal tunnel syndrome. Consider other risk factors. Ageing is associated with increased heel pad stiffness and plantar fascial thickening, which can contribute to plantar fasciitis. Standing for long periods is associated with a near fourfold increase and obesity a near sixfold increase in plantar fasciitis.