Clinical Diagnosis Of Plantar Fasciitis Research Articles

Corelation of hypothyroidism and dyslipidemias with plantar fasciitis in Indian population

Background: Plantar fasciitis (PF) affects millions of people but still there is lack of knowledge of all the factors involved in causing this condition. The main objective of this study is to investigate the relationship between thyroid hormones, dyslipidemias, hyperuricemia, liver and renal function tests. Methods: 200 patients were enrolled,100 with a clinical diagnosis of PF in the case group and 100 without PF in the control group. Patients thyroid profile (T3, T4, TSH), liver profile (Bilirubin, SGOT, SGPT), renal profile (Serum creatine, urea), lipid profile (serum total cholesterol, LDL, HDL, VLDL, triglyceride) and uric acid levels were checked and compared between the two groups. Results: Patients with PF had a higher TSH level with a mean of 4.33 mg/dl (range 0.64-20.56) than the control group with TSH mean of 2.51 mg/dl (range 0.51-8.78) (p<0.001). Serum cholesterol level was significantly higher in patients with PF than in the control group (p=0.002). Triglycerides (p=0.01), LDL (p<0.01), VLDL (p=0.021) were significantly higher in patients than in controls. HDL levels were found to be significantly lower in patients than in controls (p=0.003). Conclusions: Significantly higher TSH levels, serum cholesterol, serum triglyceride, serum LDL, serum VLDL and low HDL levels were seen in the Indian population suffering from PF. Thus, hypothyroidism and dyslipidemias should be evaluated while treating PF.

Validation of the Foot and Ankle Outcome Score for Use in Infracalcaneal Heel Pain

There is growing interest in adopting validated and reliable patient-reported outcome measures following surgery. While the Foot and Ankle Outcome Score (FAOS) has previously been validated for use in multiple foot/ankle conditions, it has not yet been validated in patients with infracalcaneal heel pain. In this study we aimed to validate the FAOS by looking at 4 psychometric properties of the survey: construct validity, content validity, reliability, and responsiveness, using patients in our practice with a clinical diagnosis of plantar fasciitis. A total of 150 patients (mean age 49.7 ± 12.1 years [36 men and 114 women]) were included in one or more of the 4 components of this study. All FAOS subscales demonstrated adequate construct validity when compared with the physical health component of the 12-Item Short Form Health Survey (SF-12), and 2 out of 5 subscales demonstrated moderate correlation with the mental health component of SF-12 (all Spearman rho >0.3, and p values <0.05). Most FAOS subscales demonstrated content validity and were found to contain relevant questions from the patient's perspective. All 5 subscales demonstrated good test-retest reliability with intraclass correlation coefficients ≥ 0.827. Finally, 4 out of the 5 subscales (all but other symptoms) were responsive to change at a mean follow up of 12.2 months after surgery (p < .05). We conclude that the FAOS is a responsive, reliable, and valid instrument for use in infracalcaneal heel pain. We believe that due to its ease of use and broad applicability, the FAOS could be more widely adopted in foot/ankle practices as patient-centered healthcare delivery and research becomes increasingly prioritized in the US and abroad.

Impact of routine footwear on foot health: A study on plantar fasciitis.

Plantar fasciitis is the most common cause of heel pain requiring medical attention. The clear understanding of the long-term impact routine footwear has on plantar fasciitis is essential as any slight changes in shoe selection could possibly prevent the wearer from substantial discomfort and disability. Thus this study was planned to investigate impact of routine footwear on foot health by highlighting different features of the shoes worn daily by the people having plantar fasciitis. A cross-sectional study was conducted in the orthopedics' outpatient department of a tertiary-care hospital in Pakistan. Data was collected using non-probability convenient sampling from 101 people diagnosed with plantar fasciitis. Their routine footwear was categorized as appropriate or inappropriate on basis of heel height, sole thickness, and insole type (hard/cushioned/arched). Data were collected using a self-designed questionnaire and analysed by applying descriptive statistics and non-parametric tests. The majority (83.2%) of the people wear inappropriate shoes, whereas only 16.8% wear the recommended shoes, i.e., with heel height between 0.5-4 cm, thick soles, and arched or cushioned insoles. About 82.2% of plantar fasciitis patients reported wearing shoes of minimal heel height and 55.5% wore shoes with hard, non-cushioned insole without built-in arch support. Participants who wear inappropriate shoes experience more severe heel pain (P 0.013) which limits their daily activities. Footwear plays an important role in causing plantar fasciitis as the majority of the diagnosed cases wear inappropriate shoes with minimal heel height, thin sole, and hard insole without any built-in arch support.

Is There a Role for MRI in Plantar Heel Pain.

There is an increasing trend to investigate plantar heel pain with magnetic resonance imaging (MRI) scan though plantar fasciitis is the most common cause. The purpose of our study was to evaluate the role of MRI in patients presenting with plantar heel pain. Case notes and MRI scans of 141 patients with a clinical diagnosis of plantar fasciitis were reviewed retrospectively. There were 98 females and 43 males patients. Fourteen patients had bilateral symptoms. Average age for male patients was 51 years (range = 26-78 years), and for female patients the average age was 52 years (range = 29-76 years). A total of 121 feet had MRI features suggestive of plantar fasciitis. MRI was normal in 32 feet. There was one case of stress fracture of calcaneus and another of a heel fibroma diagnosed on MRI scan. In our study, MRI scan was normal in 20.7% of the cases; 1.3% had a diagnosis other than plantar fasciitis but no sinister pathology. We therefore conclude that MRI scan is not routinely indicated and key is careful clinical assessment. Therapeutic, Level IV: Retrospective, Case series.

Comparative study on functional outcome of steroid injection vs conservative management in plantar Fascitiis

Plantar fasciitis is the most commonly encountered cause of heel pain often presenting after periods of inactivity. Since its aetiology is obscure, there exist multiple modalities of treatment including both conservative and local injection of steroid. This study aims to evaluate the functional outcome following steroid injection versus conservative management of plantar fasciitis. Sixty two patients with heel pain with clinical diagnosis of plantar fasciitis in whom other causes of heel pain was ruled out were included. One group received plantar fascia stretching exercise, NSAID treatment and footwear modification while the other group received local steroid injection in addition to the exercises and footwear modification and NSAIDS. The VAS scores were re assessed on admission and after 2, 4 and 8 weeks. The conservative group showed a slow decline in VAS scores over 8 weeks whereas the steroid group showed a rapid fall in the first two weeks and a plateau at the end of 8 weeks with no major VAS score difference. There is a statistically significant drop in pain and VAS scores in the steroid group on comparing with the conservative group at 2 and 4 weeks follow up. However there was no significant difference in the VAS scores of steroid injection and stretching exercises by the 8th week. Since, local injection of steroid can sometimes causes unwarranted complications such as heel pad atrophy or Achilles tendon rupture, conservative management is preferred. However with good patient selection and adequate precaution steroid injection can be used for rapid pain relief and early return to activities.

Biomechanical Parameters in Plantar Fasciitis Measured by Gait Analysis System With Pressure Sensor.

ObjectiveTo investigate the differences in biomechanical parameters measured by gait analysis systems between healthy subjects and subjects with plantar fasciitis (PF), and to compare biomechanical parameters between ‘normal, barefooted’ gait and arch building gait in the participants.MethodsThe researchers evaluated 15 subjects (30 feet) with bilateral foot pain and 15 subjects (15 feet) with unilateral foot pain who had a clinical diagnosis of PF. Additionally, 17 subjects (34 feet) who had no heel pain were recruited. Subjects were excluded if they had a traumatic event, prior surgery or fractures of the lower limbs, a leg length discrepancy of 1 cm or greater, a body mass index greater than 35 kg/m2, or had musculoskeletal disorders. The participants were asked to walk with an arch building gait on a treadmill at 2.3 km/hr for 5 minutes. Various gait parameters were measured.ResultsWith the arch building gait, the PF group proved that gait line length and single support line were significantly decreased, and lateral symmetry of the PF group was increased compared to that of the control group. The subjects with bilateral PF displayed significantly increased maximum pressure over the heel and the forefoot during arch building gait. In addition, the subjects with unilateral PF showed significantly increased maximum pressure over the forefoot with arch building gait.ConclusionThe researchers show that various biomechanical differences exist between healthy subjects and those with PF. Employing an arch building gait in patients with PF could be helpful in changing gait patterns to normal biomechanics.

Ultrasound guided injection of platelet rich plasma in cases of chronic plantar fasciitis

Chronic plantar fasciitis (PF) is, by far, considered one of the commonest causes of foot complaints; constituting up to 15% of the foot symptoms that needs medical care in adult and active subjects. PurposeIs to confirm the clinical diagnosis of plantar fasciitis by ultrasound and to depict the effect of ultrasound guided injection of PRP in such cases. MethodsThe study was conducted on 44 patients with chronic plantar fasciitis not responding to conservative treatment, they were diagnosed and were treated by ultrasound guided PRP injection then followed-up after 4months by both clinical and ultrasound examinations. ResultsBy ultrasound mild improvement in plantar fascia thickness from 6.04mm (mean of pre injection) to 4.93mm (mean of 4months post last injection). By VAS, significant improvement from 8.14 (mean of pre injection) to 2.59 (mean of 4months post injection). By Roles and Maudsley score, significant improvement from 81.8% of patients who were acceptable and 18.2% were poor (pre injection) to 59.1% became excellent, 31.8% good, 4.5% acceptable and 4.5%poor (4months post injection). ConclusionUltrasound is a confirmatory diagnostic tool of PF and PRP ultrasound guided injection is recommended after failure of conservative treatment.

Plantar fasciitis: A randomized comparative study of platelet rich plasma and low dose radiation in sportspersons

BackgroundPlantar Fasciitis makes up about 15% of patients requiring professional care due to foot symptoms. The treatment methods are numerous with none proving to be clearly superior to others. We aimed to compare two common treatment methods in search of the best treatment. MethodAll consecutive sportspersons presenting to our OPD with clinical diagnosis of plantar fasciitis underwent treatment consisting of stretching exercises, activity modification, and NSAID’s for 6 months. First 40 patients who did not respond to the treatment were divided randomly into two groups of 20 patients each, Group A (Platelet rich plasma − PRP) and Group B (low dose radiation − LDR). At the time of final follow-up (6 months) the mean improvement in the pain score (Visual-Analogue-Scale), American Orthopaedic Foot and Ankle Score (AOFAS) and Plantar fascia thickness on ultrasound were compared. ResultSignificant improvement in all 3 parameters was noted at the time of final follow up within both groups. When compared to each other, the difference in outcome of both these Groups on the given 3 parameters came out to be insignificant (p>0.05). ConclusionPRP is as good as LDR in patients with chronic recalcitrant plantar fasciitis not responding to physical therapy.

Effectiveness of polydeoxyribonucleotide injection versus normal saline injection for treatment of chronic plantar fasciitis: a prospective randomised clinical trial.

Polydeoxyribonucleotide (PDRN) has been used for the treatment of chronic tendinosis. This prospective randomised study was conducted to evaluate the efficacy and complications of PDRN injection for treatment of plantar fasciitis. Forty patients with a clinical diagnosis of plantar fasciitis were randomly allocated to PDRN injection (PDRN group, n = 20) or normal saline injection (placebo group, n = 20). Injections were performed weekly for three weeks. Clinical evaluations were done at baseline and four and 12 weeks after treatment began using the visual analogue scale (VAS) for foot pain and Manchester-Oxford Foot Questionnaire (MOXFQ). We also monitored the complications in both groups at one, two, four and 12 weeks after initial treatment. The PDRN group achieved a significant improvement in VAS and MOXFQ scores at four weeks after treatment, and this improvement continued until 12 weeks after treatment. On the other hand, the placebo group did not achieve a significant improvement in the VAS or MOXFQ scores at four or 12 weeks. The initial VAS and MOXFQ scores of the PDRN group were not significantly different from those of the placebo group. At four weeks after treatment, the VAS and MOXFQ scores of the PDRN group were better than those of the placebo group, but the difference was not statistically significant. At 12 weeks after treatment, the VAS and MOXFQ scores of the PDRN group were significantly better than those of the placebo group. We noticed no injection-related complications, such as itching, urticaria, redness or infection signs around the injection site in either group. PDRN injection is an effective and safe treatment option and may be considered for plantar fasciitis.

Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: A randomized, placebo-controlled trial.

Background:Plantar fasciitis is the most common cause of heel pain. Extracorporeal shock wave therapy (ESWT) is an alternative treatment for refractory cases of plantar fasciitis. Studies also demonstrated that ESWT may be an appropriate treatment for myofascial trigger points. This study was designed to evaluate its effectiveness by comparing the ESWT of Gastrocnemius/Soleus (gastroc-soleus) trigger points and heel region with the ESWT of the heel region alone.Materials and Methods:The study was carried out among 40 patients with a clinical diagnosis of plantar fasciitis, divided randomly to case (n = 20) and control (n = 20) groups. The case group received ESWT for the heel region and for the gastroc-soleus trigger points. The control group received ESWT just for the heel region. The protocol was the same in both groups and they were treated for three sessions every week. The pain score (100 mm visual analog score [VAS]) and the modified Roles and Maudsley score was evaluated before the first session and eight weeks after the last session.Results:Eight weeks after the last session, although the mean VAS had decreased significantly in both groups, this decrement was more significant in the case group. (P = 0.04). According to the modified Roles and Maudsley score, there was a significant improvement in both the case (P < 0.001) and control (P = 0.01) groups, eight weeks after treatment, but there were significantly better results in the case group.Conclusion:The combination of ESWT for both plantar fasciitis and gastroc-soleus trigger points in treating patients with plantar fasciitis is more effective than utilizing it solely for plantar fasciitis.

Long-Term Outcome of Low-Energy Extracorporeal Shock Wave Therapy for Plantar Fasciitis: Comparative Analysis According to Ultrasonographic Findings

ObjectiveTo investigate the long-term effect of low-energy extracorporeal shock wave therapy (ESWT) for plantar fasciitis (PF) according to ultrasonography (US) findings.MethodsThirty feet of 25 patients with clinical diagnosis of PF were enrolled and divided into two groups (Apparent-US and Uncertain-US) according to US findings, such as plantar fascia thickening or hypoechogenicity. Inclusion criteria were symptom duration >6 months and a fair or poor grade in Roles-Maudsley score (RMS). ESWT (0.10 mJ/mm2, 600 shocks) was given once a week for 6 weeks. Numeric rating scale (NRS) and RMS were evaluated prior to each ESWT session, at short-term follow-up (one week after all ESWT sessions) and long-term follow-up telephone interview (mean 24 months after ESWT). Good and excellent grade in RMS were considered as treatment success.ResultsRepeated measure ANOVA demonstrated that NRS significantly decreased with time after ESWT up to the long-term follow-up (time effect, p<0.001) without group-time interaction (p=0.641), indicating that ESWT equally decreased pain in both groups. Overall success rate was 63.3% (short-term follow-up) and 80.0% (long-term follow-up). In comparative analysis between groups, success rate of Apparent-US and Uncertain-US at short-term follow-up was 61.9% and 66.7%, respectively, and 85.7% and 66.7%, respectively, at long-term follow-up.ConclusionIf other causes of heel pain are ruled out through meticulous physical examination and ultrasonography, low-energy ESWT in PF seems to be beneficial regardless of US findings. In terms of success rate, however, long-term outcome of Apparent-US appears to be superior to Uncertain-US.

Comparison of Stretching Exercises and Corticosteroid Injection in Pain Reduction of Patients with Plantar Fasciitis

Introduction: Plantar fasciitis is the most common cause of heel pain. Because its cause is uncertain, there is a lot of treatment methods for it. Our study compares the results of two most common treatments known as steroid injection and plantar fascia stretching with each other regard to decrease in pain and improvement in function. Materials and methods: 66 patients with heel pain with clinical diagnosis of plantar fasciitis which other causes of heel pain are ruled out in them are studied. One group with local steroid injection and the other group with plantar fascia stretching exercises. After 2 and 8 weeks, they are re evaluated regard to function and pain scores. Results: There is no difference between two groups regard to sex, age, height , weight and body mass index . There was significant decrease in pain and improvement in function steroid group , but, in the 8 th week, two groups have the same results in those manners. Discussion: It seems that because after 8 weeks of treatment with both therapeutic methods, the results were the same, it is better to use the less complicated and less expensive method (stretching) , but in cases which prompt pain relief and better function is desired, steroid injection may be better.

Randomized controlled study of the efficacy of the injection of botulinum toxin type A versus corticosteroids in chronic plantar fasciitis: results at one and six months

Objective: To determine the efficacy of botulinum toxin type A in chronic plantar fasciitis compared to the local injection of a corticosteroid plus local anaesthetic. Methods: Patients with a clinical diagnosis of plantar fasciitis made at least six months earlier were selected to enter a randomized, single-blind study of treatment with injections of botulinum toxin type A or corticosteroid. There were 28 patients in each treatment group. Patients were evaluated at one month using the Foot Health Square Questionnaire and those with no clinical response subsequently received a second injection with the drug of the other arm of the study, creating two new treatment groups. Re-evaluation was performed at six months. Results: One month after injection there was a clear clinical improvement in both treatment groups but it was greater in the botulinum toxin group, with a significant difference for the pain item (P = 0.069), though not in other items. At six months, patients treated with botulinum toxin type A had continued to improve in all items, whereas the corticosteroid group lost part of the improvement achieved at one month (improvement with botulinum toxin vs. corticosteroid: pain 19.10/–6.84 (P = 0.001), function 16.00/–8.80 (P < 0.001), footwear 13.48/–7.95 (P = 0.004), self-perceived foot health 25.44/–5.41 (P < 0.001). Conclusion: Botulinum toxin type A should be considered for the treatment of chronic plantar fasciitis in view of the improvement found at one month, and particularly at six months, when this treatment clearly has better results than corticosteroid injections. Further studies with larger samples are necessary to confirm these results.

Biomechanical Factors Associated with Plantar Fasciitis in Non-obese Patients

The purpose of this study was to identify the biomechanical factors that correlate with plantar fasciitis in non-obese patients whose body mass index were below 25 kg/m 2 . The subjects were non-obese patients who were diagnosed as plantar fasciitis by clinical appearance, physical examination, and ultrasonographic findings (n=48), and non-obese control persons without clinical diagnosis of plantar fasciitis (n=30). The two groups were compared on fat pad thickness, ankle dorsiflexion range of motion (ROM), resting calcaneal stance position (RCSP), incidence of calcaneal spur, and calcaneal pitch. The results showed that, there were statistically significant differences between two groups in ankle dorsiflexion ROM, RCSP, and calcaneal pitch (p ＜0.05). Multiple logistic regression analysis showed ankle dorsiflexion ROM and RCSP strongly correlated with presence of plantar fasciitis as independent predictors (p ＜0.05). In conclusion, reduced ankle dorsiflexion ROM and negative RCSP (valgus tendency in rear foot) may be the biomechanical factors associated with plantar fasciitis in non-obese patients. Key W ords: Plantar fasciitis, Biomechanical factors, Non-obese patients

MRI of plantar fasciitis

The purpose of this study was to determine the type and frequency of characteristic bone and soft tissue changes on MRI of patients with a clinical diagnosis of plantar fasciitis. 28 patients with a clinical diagnosis of plantar fasciitis underwent MR imaging. Besides T1- and T2-weighted sequences, short-tau-inversion-recovery sequences were used routinely. In 27 patients T1-weighted images after intravenous contrast injection were acquired additionally. As a control group the images of 15 patients without clinical signs for plantar fasciitis were evaluated. In 25 of 28 cases (89%) the clinical diagnosis of plantar fasciitis was established by MR imaging. The most common finding was a peritendinous edema at the calcaneal insertion site which was found in all 25 patients. In 19 of 25 cases (76%) a bone marrow edema of the calcaneus was present. In 14 of 25 cases (56%) an intratendinous signal intensity increase of the plantar fascia could be observed which showed contrast enhancement in 12 cases. Compared to the control group (mean thickness 3.3 mm) the plantar fascia showed significant thickening in the 25 MR positive patients (mean thickness 6.72 mm). Besides thickening of the plantar fascia and intratendinous signal intensity increase with contrast enhancement to some extent, bone marrow edema of the calcaneus and peritendinous edema close to the plantar fascia are characteristic signs of plantar fasciitis on MRI. Both signs can reliably be seen on STIR sequences only.

Plantar fasciitis: detection with ultrasonography versus bone scintigraphy

Purpose: To compare ultrasonography (US) with three-phase bone scintigraphy (BS) for detection of plantar fasciitis (PF). Materials and methods: Forty-three consecutive patients with a clinical diagnosis of PF were prospectively studied with US and BS. There were 58 symptomatic feet and 28 asymptomatic feet. US positive findings for PF were thickness of the proximal plantar fascia> 3.9 mm (T) and hypoechoic fascia (H). Focal uptake at the medial calcaneus tuberosity in the early and delayed images were used as BS positive findings for PF. Receiver operating characteristic (ROC) methodology was used to analyze the results. Sensitivity, specificity, positive and negative predictive values, and accuracy in diagnosis of plantar fasciitis were calculated for both modalities. Results: The mean area under the ROC curve, indicating successful diagnosis of PF, was 81.6% for BS, 76.5% for T and 81.8% for H (P> 0.25). The sensitivities were 77.6%, 74.1% and 70.7%, respectively for BS, T, and H (P>0.39). The specificity of BS (85.7%) did not differ significantly from the specificity of H (92.9%, p=0.20). Plantar fascia thickness specificity (71.4%) was significantly lower than BS (P =0.038) and H (P =0.0000). There were no statistically significant differences between positive and negative predictive values. Also, in 10 patients (23%), other causes of foot pain were found by BS. Conclusion: US and BS demonstrate no statistically significant difference in ability to demonstrate plantar fasciitis in patients with heel pain.

Complications of Plantar Fascia Rupture Associated with Corticosteroid Injection

From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection. The authors injected 122 of the 765 patients, resulting in 12 of the 44 plantar fascia ruptures. Subjective and objective evaluations were conducted through chart and radiographic review. Thirty-nine of these patients were evaluated at an average 27-month follow-up. Thirty patients (68%) reported a sudden onset of tearing at the heel, and 14 (32%) had a gradual onset of symptoms. In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. All patients exhibited diminished tension of the plantar fascia upon examination by the stretch test. Comparison of calcaneal pitch angles in the affected and uninvolved foot showed a statistically significant difference of 3.7 degrees (P = 0.0001). Treatment included NSAIDs, rest or cross-training, stretching, orthotics, and boot-brace immobilization. At an average 27-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve.

Plantar fasciitis: sonographic evaluation.

To evaluate the sonographic findings of plantar fasciitis. Both feet of 15 patients who had a clinical diagnosis of plantar fasciitis were evaluated with ultrasound (US) by using a 7.0-MHz linear-array transducer. Heel pain was unilateral in 11 patients and bilateral in four. Sagittal sonograms were obtained, and the thickness of the plantar fascia was measured at its proximal end near its insertion into the calcaneus. Other observations included hypoechoic fascia, fiber rupture, perifascial fluid collections, and calcifications. Both feet of 15 healthy volunteers were also evaluated as a control group. Plantar fascia thickness was significantly increased in the heels in patients with plantar fasciitis (3.2-6.8 mm; mean, 5.2 mm +/- 1.13) compared with their asymptomatic heels (2.0-4.0 mm; mean, 2.9 mm +/- 0.70) (P < .0001) and compared with the heels of the patients in the control group (1.6-3.8 mm; mean, 2.6 mm +/- 0.48) (P < .0001). The proximal plantar fascia of 16 (84%) symptomatic heels were diffusely hypoechoic compared with none of the patients' asymptomatic heels and only one heel of a patient in the volunteer group. No fascia rupture, perifascial fluid collection, or calcifications were identified. Increased thickness of the fascia and hypoechoic fascia are sonographic findings of plantar fasciitis. US may be a valuable noninvasive technique for the diagnosis of plantar fasciitis.

Outcome of nonsurgical treatment for plantar fasciitis.

Four hundred eleven patients with a clinical diagnosis of plantar fasciitis were assessed for predisposing factors. Each patient completed an outcomes assessment survey instrument that ranked effectiveness of various nonsurgical treatment modalities. Listed in descending order of effectiveness, the treatment modalities assessed were short leg walking cast, steroid injection, rest, ice, runner's shoe, crepe-soled shoe, aspirin or nonsteroidal anti-inflammatory drug, heel cushion, low-profile plastic heel cup, heat, and Tuli's heel cup. Treatment with a cast ranked the best. The Tuli's heel cup ranked the poorest. Most of the treatments were found to be unpredictable or minimally effective. The ineffectiveness of nonsurgical treatments noted in this outcomes study is at variance with most published clinical studies in which generally favorable results are reported after nonsurgical treatment for plantar fasciitis.