From the Guidelines
Treatment for plantar fasciitis should begin with conservative measures, including rest, ice application, and stretching exercises targeting the plantar fascia and Achilles tendon, as well as the use of open-backed shoes, orthoses, and NSAIDs, as recommended by the American College of Foot and Ankle Surgeons 1.
Initial Treatment
The initial treatment options for plantar fasciitis may include:
- Open-backed shoes to reduce pressure on the area
- Heel lifts or orthoses to provide additional support
- NSAIDs to reduce pain and inflammation
- Decreased activity to avoid exacerbating the condition
- Stretching exercises, such as calf stretches and toe stretches, to improve flexibility and reduce tension in the plantar fascia
- Weight loss, if indicated, to reduce the strain on the plantar fascia
Additional Treatment Options
If symptoms persist, additional treatment options may be considered, including:
- Customized orthotic devices to provide additional arch support
- Night splinting to maintain a gentle stretch on the plantar fascia during sleep
- A limited number of corticosteroid injections to reduce inflammation
- Casting or use of a fixed-ankle walker-type device to immobilize the foot and reduce stress on the plantar fascia
- Physical therapy to improve strength and flexibility in the foot and ankle
- Extracorporeal shock wave therapy to stimulate healing and reduce inflammation
Referral to a Specialist
If no improvement occurs after six weeks of treatment, referral to a podiatric foot and ankle surgeon is appropriate 1. The specialist can evaluate the patient and provide additional treatment options, such as surgery or further immobilization. It is essential to continue initial treatment measures and add new treatments as needed to achieve the best possible outcome for the patient, with the goal of improving morbidity, mortality, and quality of life 1.
From the Research
Treatment Options for Plantar Fasciitis
- Conservative measures are often recommended as the first line of treatment, including the use of plantar insoles and stretching exercises focused on the plantar fascia 2
- Corticosteroid injections and iontophoresis with steroids have also demonstrated limited evidence of benefit, although the effect is often short-term 2
- Platelet-rich plasma injections have shown promise in treating chronic plantar fasciitis, with some studies suggesting it may be as effective as or more effective than corticosteroid injections 3, 4
- Minimally invasive treatment options, such as shockwave therapy and plantar fasciotomy, may be considered for patients who do not respond to conservative management 5
Efficacy of Treatment Options
- A systematic review found that the efficacy of various treatment options for plantar fasciitis is variable, and none have strong evidence of benefit 2
- A study comparing the effects of platelet-rich plasma, corticosteroid, and placebo injections found significant improvements in pain and function in the platelet-rich plasma and corticosteroid groups, but not in the placebo group 4
- Another study found that conservative management is effective in approximately 90% of patients, although the natural history of plantar fasciitis is not well established 6
Considerations for Treatment
- The use of conservative measures, such as plantar insoles and stretching exercises, is often recommended due to their low cost and ease of use 2
- More invasive treatments, such as corticosteroid injections and surgery, may be considered for patients who do not respond to conservative management, but carry a higher risk of complications 3, 5
- The choice of treatment should be individualized based on the patient's specific needs and circumstances 6, 4