Consider referring a patient with plantar fasciitis to a specialist if:
- There is diagnostic uncertainty about the condition.
- Symptoms are severe and significantly impact daily function.
- Symptoms persist for 3 to 6 months despite appropriate management in primary care.
- Additional imaging or investigations are needed to exclude alternative diagnoses, such as plantar fascia tears or calcaneal stress fracture.
- Minimally invasive treatments like extracorporeal shockwave therapy (ESWT) or corticosteroid injections are being considered and require specialist expertise.
- Surgical options are being contemplated, especially if symptoms persist beyond 6 months and conservative treatments have failed.
Referral may be to an orthopaedic surgeon or other relevant specialists depending on local pathways and clinical judgement.
Initial referral to allied health professionals such as podiatrists, orthotists, or physiotherapists is appropriate if self-care and home exercises are ineffective or unsatisfactory.
Imaging such as weight-bearing foot X-rays, ultrasound, or MRI may be arranged prior to or during specialist referral to clarify diagnosis and guide management.
Electrophysiologic studies may be useful to exclude alternative diagnoses like tarsal tunnel syndrome or nerve entrapment.
Overall, specialist referral is indicated when conservative management fails, diagnosis is unclear, or advanced treatments are needed.
References: NICE CKS