Synopsis
Recognise the characteristic first-step medial heel pain of plantar fasciopathy, exclude stress fracture, nerve, inflammatory and malignant causes, and deliver progressive load, flexibility and footwear care without overusing imaging or injections.
- The classic symptom is medial plantar heel pain on the first steps after waking or sitting, easing with initial movement and returning after prolonged standing, walking or running.
- High-yield examination findings are tenderness at the medial calcaneal tubercle and reproduction with passive great-toe dorsiflexion or the windlass manoeuvre.
- First-line investigation is clinical assessment; routine radiographs, ultrasound and MRI are unnecessary in a typical presentation without red flags.
Key red flags
A fall, sudden training increase or osteoporosis risk with diffuse calcaneal squeeze pain and inability to bear weight suggests stress or acute fracture.
Investigation priorities
Confirm characteristic timing and medial fascial-origin tenderness and screen fracture, nerve, inflammatory and systemic alternatives.
Management branches
First-step medial heel pain and focal fascial-origin tenderness occur without red flags.
- Map pain precisely and reproduce it at the medial calcaneal origin with palpation and gentle windlass loading.
- Check calcaneal squeeze, fat pad, Achilles, tarsal tunnel, ankle dorsiflexion, skin, sensation and pulses.
Key medicines
Topical diclofenac gelUse 2–4 g of diclofenac 1.16% gel over intact medial-heel skin at each application, up to three or four applications daily for a brief trial within the licensed maximum.
Short-course oral naproxen with protection when suitableIf symptoms prevent rehabilitation and risks are acceptable, use naproxen 250–500 mg orally twice daily with food briefly and add omeprazole 20 mg once daily during treatment when gastroprotection is indicated.