Plantar fasciitis is one of the most common causes of inferior heel pain and represents a degenerative disorder of the plantar fascia rather than a purely inflammatory condition. The plantar fascia is a thick fibrous band of connective tissue extending from the medial tubercle of the calcaneus to the toes, playing a crucial role in maintaining the longitudinal arch of the foot and absorbing mechanical forces during standing and gait. Repetitive microtrauma and overload lead to collagen degeneration, microtearing, and loss of normal tissue elasticity at its calcaneal origin.

The condition frequently develops due to biomechanical overload rather than a single traumatic event. Risk factors include prolonged standing or walking, sudden increase in activity level, inadequate footwear, obesity, reduced ankle dorsiflexion, tight calf musculature, and abnormal foot mechanics such as pes planus or pes cavus. Plantar fasciitis is commonly seen in both athletic and non-athletic populations and may significantly impair mobility and occupational function.

Patients classically describe sharp, stabbing pain localized to the medial aspect of the heel, particularly with the first steps in the morning or after prolonged periods of rest. Pain often improves with initial activity but may worsen after prolonged standing, walking, or at the end of the day. As the condition becomes chronic, pain may persist throughout activity and alter gait mechanics, leading to secondary problems in the ankle, knee, hip, or lower back.

Orthopaedic evaluation begins with a detailed clinical history and physical examination. Point tenderness at the medial calcaneal tubercle is a hallmark finding. Assessment of foot posture, arch height, calf muscle flexibility, and ankle range of motion is essential to identify contributing biomechanical factors. Imaging is not routinely required for diagnosis but may be used to exclude alternative causes of heel pain in atypical or refractory cases.

Management of plantar fasciitis is predominantly conservative and focuses on load reduction and correction of biomechanical contributors. Treatment strategies include activity modification, stretching of the plantar fascia and Achilles tendon, strengthening of intrinsic foot muscles, and footwear modification to improve shock absorption and arch support. Patient education is a critical component, as recovery is often gradual and requires adherence to a structured program.

Adjunctive treatments may be considered in patients with persistent symptoms. These are aimed at symptom relief rather than cure and should be integrated with biomechanical correction. The majority of patients experience significant improvement within months when conservative treatment is followed consistently.

Surgical intervention is rarely required and is reserved for patients with chronic, debilitating symptoms that fail to respond to prolonged conservative management. Surgical objectives include releasing pathological tension in the plantar fascia while preserving foot stability. Careful patient selection is essential, as surgery does not address underlying biomechanical dysfunction.

Plantar fasciitis requires a comprehensive orthopaedic approach addressing mechanical overload, foot biomechanics, and functional rehabilitation to achieve durable symptom resolution and restore normal gait.