Plantar fasciitis: epidemiology, pathophysiology, diagnosis, and evidence-based treatment

Introduction: Plantar fasciitis, the most common cause of heel pain in adults, is increasingly understood as a degenerative, load-related fasciopathy rather than a purely inflammatory condition, with a substantial impact on quality of life. Objective: To comprehensively describe the current state of knowledge on plantar fasciitis, covering its epidemiology and risk factors, pathophysiological mechanisms, diagnostic strategies, and conservative, injection-based, and surgical treatment. Methods: A narrative literature review was conducted through searches in PubMed/MEDLINE and SciELO, using the Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) “fasciitis, plantar,” “heel,” “risk factors,” “ultrasonography,” “extracorporeal shockwave therapy,” and “platelet-rich plasma.” Development: Heel pain affected 11.1% of adults in a U.S. national survey, and higher body mass index and a greater range of ankle plantarflexion are associated with the condition. Diagnosis is clinical, with ultrasonography as a reliable complement. Custom foot orthoses and taping relieve pain in the short term; in a meta-analysis of 236 studies, extracorporeal shockwave therapy was the only intervention that maintained its effect at medium and long term; the evidence on injections is heterogeneous, and surgery is reserved for recalcitrant cases. Conclusions: Plantar fasciitis should be managed as a multifactorial overload condition through a stepwise, individualized approach. Standardizing therapeutic protocols and generating regional data are necessary to reduce variability in clinical practice.