THE PREVALENCE, ASSESSMENT, AND MANAGEMENT OF PLANTAR FASCIITIS: A SYSTEMATIC REVIEW

Abstract

Background: Plantar fasciitis is the most common cause of plantar heel pain in adults and a frequent reason for outpatient and specialist consultation. Evidence on its prevalence, diagnostic assessment, and comparative management is dispersed and heterogeneous, and few overviews integrate these three dimensions within a single transparent framework.

Objective: To systematically identify, appraise, and synthesise existing systematic reviews and primary studies reporting on the prevalence, assessment, and management of plantar fasciitis in adults, and to summarise the effectiveness of the principal treatment modalities.

Methods: A structured systematic review was conducted in accordance with PRISMA 2020. PubMed, MEDLINE, Cochrane Library, CINAHL, and Scopus were searched, supplemented by reference and citation screening. A PICOS framework defined eligibility, and selection followed a two-stage screening process. Methodological quality was appraised with AMSTAR-2 (reviews), the JBI checklist (prevalence studies), and Cochrane/QUADAS-2-informed criteria (primary studies), harmonised into one risk-of-bias matrix. A narrative synthesis was used because heterogeneity precluded meta-analysis.

Results: Fifteen studies were included (nine review-level, six primary). Point prevalence was ~0.85 1% of adults, with a two- to three-fold female predominance, a peak at 45 64 years, an approximately five-fold excess in obese adults, and an incidence of 4.5 10% in runners. Diagnosis was primarily clinical (first-step morning pain, medial calcaneal tenderness, positive windlass test), with ultrasound (fascia thickness >4 mm, hypoechogenicity) as first-line imaging and MRI reserved for atypical cases. More than 80 90% of patients improved with conservative care over 6 18 months. Orthoses, fascia-specific stretching, and taping were likely beneficial; short-term corticosteroid injection was likely beneficial short-term but harmful longer-term; shockwave therapy and regenerative injections benefited chronic disease; surgery was a last resort. Most effectiveness estimates rested on low- or very-low-certainty evidence.

Conclusion: Plantar fasciitis is common, degenerative rather than inflammatory, diagnosed clinically and confirmed by ultrasound, and largely self-limiting under a stepwise, low-risk-first strategy. The evidence base is dominated by heterogeneous, low-certainty studies; adequately powered head-to-head trials with standardised outcomes are needed.