Prognosis, Risk Factors and a Stepwise Approach to Treatment

Two years after treatment about 40% still have symptoms, and in a specialized clinic half of severe cases still had symptoms after ten years. Symptoms for more than seven months, female sex, age under 40 and bilateral pain predict a worse outcome, while BMI, fascia thickness and heel spurs do not. In non-runners a high BMI is linked to the condition, but those studies cannot show which came first. In runners, prospective data link genu varum, track spikes, a cavus foot and higher weekly and lifetime running volume to higher risk. Treatment aims to restore the balance between load and capacity. Runners can keep running if it does not flare symptoms, replacing the rest with walking, cycling or swimming. Weight loss and fewer standing hours may also help. A recent best practice guide starts with education, plantar fascia stretching and taping, then adds shockwave, custom orthoses and a corticosteroid injection if needed. Henrik's own sequence moves from advice and insoles to heavy slow resistance training, then injection or shockwave, with surgery last.