Plantar fasciopathy: a comprehensive, evidence-based guide for diagnosis and treatment

Plantar fasciopathy is a prevalent cause of heel pain, often mischaracterized as an inflammatory condition. It primarily affects individuals aged 40 to 60, with risk factors including foot biomechanics, obesity, and prolonged standing. Diagnosis relies on clinical assessment, incorporating validated tests such as the Windlass and Foot Posture Index tests, alongside imaging when necessary. Treatment follows a stepwise approach based on foot morphology, starting with conservative measures such as activity modification, targeted stretching of the plantar fascia and calf muscles, footwear optimization, and orthotic support. If symptoms persist beyond 8-12 weeks, shockwave therapy and, in refractory cases, corticosteroid or platelet-rich plasma injections may be considered. Surgery remains a last resort. A personalized treatment strategy based on biomechanical evaluation and patient-specific factors is crucial for successful outcomes. This guide provides an evidence-based framework for clinicians to accurately diagnose and effectively manage plantar fasciopathy.