Comprehensive Review and Evidence-Based Treatment Framework for Optimizing Plantar Fasciitis Diagnosis and Management.

Plantar fasciitis, a prevalent cause of heel pain, results from inflammation of the plantar fascia, often due to repetitive stress and overuse. This comprehensive review and evidence-based treatment framework for optimizing plantar fasciitis diagnosis and management aims to inform podiatric surgeons (foot and ankle surgeons), primary care physicians, orthopedic surgeons, physical therapists, sports medicine specialists, and other medical practitioners. Developed through a literature review from mostly 2020 to 2025 using PubMed and Cochrane, this framework integrates high-quality evidence in the pathophysiology and treatment of plantar fasciitis. Diagnosis relies on detailed patient history, physical examination (including palpation, windlass test, and heel squeeze test), and selective imaging (X-rays, ultrasound, or Magnetic Resonance Imaging (MRI)) to confirm plantar fasciitis and rule out differentials such as tarsal tunnel syndrome or calcaneal stress fractures. A four-phase plantar fasciitis treatment framework categorizes 30 plantar fasciitis treatments into initial therapies, intermediate therapies, specialized therapies, and last-resort surgical therapies. Initial therapies (e.g., Rest, Ice, Compression, Elevation (RICE), stretching, orthotics) focus on early symptom relief, while intermediate (e.g., photobiomodulation therapy (PBMT), extracorporeal shock wave therapy (ESWT)) and specialized therapies (e.g., platelet-rich plasma (PRP), dry needling) address persistent cases. Surgical options like endoscopic plantar fascia release are reserved for recalcitrant cases. Recommendations prioritize low-risk, high-efficacy interventions, progressing to invasive treatments only when necessary, ensuring tailored management to optimize patient outcomes and minimize complications.