The plantar aponeurosis is a flat band of connective tissue that supports the arch of the sole of the foot. It runs from the calcaneal tuberosity to the base of the toes. Overuse and increased strain on the plantar aponeurosis, such as excessive running and standing, and increased body weight, can lead to micro-tears and degeneration within the aponeurosis at the heel with disorganization of the collagen fibers. Patients typically present with mild to severe heel pain, which appears thickened on imaging (Fig. 6.121). It is usually successfully treated with intense physiotherapy, but may require image-guided injection therapies. In severe cases, the diseased section of the fascia needs to be surgically removed.