From the Guidelines
Plantar fasciitis treatment should begin with conservative measures, including open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss, as these methods have been shown to be effective in reducing symptoms and improving quality of life 1. When treating plantar fasciitis, it is essential to prioritize conservative measures to minimize the risk of complications and promote optimal recovery.
- Initial treatment options 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 to improve flexibility and reduce tension
- Weight loss, if indicated, to reduce the strain on the plantar fascia
- If improvement occurs within six to eight weeks, these treatments should be continued until symptoms resolve 1.
- In cases where no improvement occurs after six weeks, referral to a podiatric foot and ankle surgeon is appropriate, and additional treatments may be considered, such as customized orthotic devices, night splinting, or limited corticosteroid injections 1.
- It is crucial to note that local injections of corticosteroids are not recommended as an initial treatment option, and immobilization may be considered in particularly acute or refractory cases 1.
From the Research
Treatment Options for Plantar Fasciitis
- Conservative therapies are commonly used to treat plantar fasciitis, including rest, ice massage, stretching of the Achilles tendon and plantar fascia, nonsteroidal anti-inflammatory medications (NSAIDs), corticosteroid injections, foot padding, taping, shoe modifications, arch supports, heel cups, custom foot orthoses, night splints, ultrasound, and casting 2
- Oral NSAIDs may increase pain relief and decrease disability in patients with plantar fasciitis when used with a conservative treatment regimen, although the evidence is limited 2
- Conservative management is considered first-line treatment and is effective in approximately 90% of patients, although the natural history of plantar fasciitis has not been established 3
Minimally Invasive Treatment Options
- Minimally invasive treatment options are typically reserved for those who fail conservative management, and include techniques such as corticosteroid injections and iontophoresis with steroids 4, 5
- Local injection of steroid is more effective in the treatment of plantar fasciitis than oral NSAIDs, with significant pain relief and sustained improvement 6
Evidence-Based Recommendations
- An evidence-based review of treatments of plantar fasciitis suggests that conservative measures, such as plantar soft insoles and specific stretching plantar fascia exercises, should be recommended first 5
- Limited evidence suggests that steroid injection or iontophoresis may be useful, but of transient effect, when conservative options fail 5