Plantar Fasciitis Nursing Guide

Content written by Edward Bartels, RN, BSN, MICN

Planter Fasciitis Overview

This content is intended as a Quick Reference for Planter Fasciitis and will cover an overview as well as nursing considerations utilizing the nursing process.

Etiology and Epidemiology

The planter fascia is an integral part of normal foot biomechanics. Plantar fasciitis leads to heel or foot pain and disruption in normal foot function. True causation of planter fasciitis remains unknown but is believed to be related to ligamentous microtrauma secondary to prolonged running or walking. The condition is triggered by a ligament strain in the planter fascia area of the foot.

The planter fascia is made up of fibrocartilaginous bands that attach the calcaneus tuberosity or heel bone, to the forefoot. The fascia supports normal foot motion and the weight bearing of the toes when the heel rises during walking. Prolonged running, jumping, or standing place added strain on the planter fascia.

Many individuals with plantar fasciitis experience recovery of symptoms with or without the conventional treatments of:

• Over the counter anti-inflammatory and pain medicines such as:
  • Ibuprofen (Motrin®)
  • Acetaminophen (Tylenol®)
• Rest
• Cool applications
• Stretching

Planter fasciitis demonstrates a peak incidence in adults 40 to 60 years of age and is more common in (DynaMed, n.d.):

• Woman
• Military personnel
• Those who stand for extended periods
• Athletes who participate on hard surfaces

About 2 million people are diagnosed with planter fasciitis annually in the U.S., with approximately 15% of all persons seeking foot care being diagnosed with planter fasciitis (DynaMed, n.d.).

Risk factors for planter fasciitis consist of:

• Obesity
• Pes planus or flat feet
• Pes cavus or high arched feet
• Achilles’ tendon shortening
• Inward foot roll or overpronation
• Decreased ankle dorsiflexion ROM
• Weak foot muscles
• Atrophy of the heel pad due to aging
• Use of inadequate footwear
• Repetitive or prolonged activity on hard surfaces
• Prolonged weight-bearing
• Insufficient stretching
• Deconditioning
• Running habits of:
  • Street running
  • Running in spiked shoes

Diagnosis

Planter fasciitis is diagnosed clinically based on a history and physical. The American Physical Therapy Association 2014 guidelines recommends assessing for (UpToDate, 2021):

• Characteristics of planter medial heel pain in relation to period of inactivity
• Heel pain after weight bearing
• Palpated pain at planter fascia proximal insertion
• Positive windless test (pain with step motion)
• Negative test result for posterior tarsal tunnel syndrome
• Limited ROM of the talocrural joint dorsiflexion
• Abnormal foot posture
• Heel pain in non-athletic people with a high body mass index (BMI)

Imaging studies specific for planter fasciitis are usually not required unless underlying conditions such as a fracture or infection are suspected or for assisting with differential diagnosis. When used, they may include (Lippincott Nursing Center, n.d.):

• Ultrasound
• X-rays
• MRI
• Bone scans

Management

Treatment protocols for planter fasciitis revolve around conservative means including:

• Medications:
  • Acetaminophen (Tylenol®)
  • NSAIDS (Motrin®, Aleve®)
  • Corticosteroid injections (Depo-Medrol®)
  • Platelet rich plasma injections
  • Botulinum toxin type A (Dysport®)
  • Extracorporeal shock wave therapy
• Therapy methodologies:
  • Stretch routines
  • Rest
  • Icing
  • Anti-pronation taping support
  • Casting
  • Orthotics
  • Manual physical therapy
  • Night splinting
  • Protective footwear
  • Massage

Surgery is rare but used if:

• Fasciotomy needed
• Severe symptoms persist
• Condition is refractory to conservative treatments for 6 to 12 months

Planter Fasciitis Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for plantar fasciitis are listed below.

Planter Fasciitis Nursing Care Plan

Assessment

• Review of daily weight bearing activities
• Ask about history of planter fasciitis or other foot problems
• Determine any history of trauma
• Assess for pain in heel of affected foot
• Determine if pain is worse:
  • At night
  • After rest
  • Post activity
• Assess ROM of foot and ankle
• Perform windless test
• Examine Achilles tendon for tension and pain
• Observe for difficulty with ambulation
• Question about decreased activity levels
• Review current footwear
• Assess sleeping habits
• Ask about and observe for features of anxiety
• Assess current knowledge and understanding of the disease process

Planter Fasciitis Nursing Diagnosis/Risk For

• Acute pain related to inflamed planter fascia as evidenced by:
  • Verbalization of pain and general discomfort
  • Elevated pulse rate
  • Facial grimacing
  • Restlessness
  • Agitation
• Anxiety related to physical condition as evidenced by:
  • Abnormal vital signs
  • Activity level
  • Tone of voice
  • Nervousness
  • Diaphoresis
  • Muscle tension
• Knowledge deficit of symptom prevention and condition management as evidenced by:
  • Request for information
  • Verbalization of problems
  • Presence of preventable complications
• Decreased mobility related to loss of full function in affected foot as evidenced by:
  • Limping
  • Need for assistive devices
  • Balance issues
  • Difficulty ambulating

Interventions

• Develop plan of care and teaching plan
• Promote rest
• Support use of ice and heat applications as ordered
• Assist with physical therapy plan
• Assist and teach use of assistive and supportive devices
• Support a relaxing atmosphere
• Encourage relaxation techniques
• Include individual in creation of teaching plan
• Provide clear explanations and demonstrations

Expected Outcomes

• Demonstrates reduced anxiety levels
• Reports decreased pain
• Shows understanding of condition, prevention, and management
• Remains free from complications
• Regains ability to perform desired activities without pain

Individual/Caregiver Education

• Diagnosis and treatments
• Signs of potential complications
• Use of assistive devices
• Stretching
• Returning to normal activity levels
• Call the provider if:
  • Pain or symptoms worsen
  • Medications they are prescribed
• Encourage the individual to follow-up with healthcare provider as recommended

Additional Information

Content Release Date

4/1/2022

Content Expiration Date

12/31/2024

Writer/Content Contributor

Edward Bartels, RN, BSN, MICN
Ed has over 30 years of clinical and teaching experience, and his areas of expertise are emergency and critical care, skilled nursing, behavioral health, occupational health, and safety, and home care. Ed served in several senior nursing leadership roles including: Emergency Services Director, Physician Practices Director, and Administrative Director of Nursing at the executive level. Ed is certified in LEAN efficiency fundamentals and tactics, which he has successfully deployed over the years in multiple settings resulting in cost savings, improved quality, and patient safety. Ed is a certified clinical nursing instructor in North Carolina. He earned his Diploma in Nursing from St. Vincent's School of Nursing in Staten Island, New York, in 1990 and Bachelor of Science in Nursing from the University of North Carolina, Greensboro in 2006. Ed is retired from the U.S. Coast Guard with 34 years.

Disclosures
Edward Bartels, RN, BSN, MICN has no relevant financial or non-financial relationship(s) with ineligible companies to disclose.

Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.

All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.

Resources

Indian Health Journal. Plantar fasciitis in physicians and nurses: A nationwide population-based study.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118066/

References

DynaMed. (n.d.). Planter fasciitis. Retrieved October 29, 2021. https://www.dynamed.com/condition/plantar-fasciitis#EXTREMITIES__ANC_1177309159 

Lippincott Nursing Center. (n.d.). Planter fasciitis: What is the diagnosis and treatment.

Retrieved October 29, 2021. https://www.nursingcenter.com/ce_articleprint?an=00006416-201407000-00007 

UpToDate. (2021). Society guideline links: Planter fasciitis. https://www.dynamed.com/condition/plantar-fasciitis#EXTREMITIES__ANC_1177309159

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