What is the management of plantar fasciitis (inflammation of the plantar fascia)?

From the Guidelines

Management of plantar fasciitis should begin with conservative measures, including rest, ice application, stretching exercises, and footwear modifications, as these approaches have been shown to improve symptoms and quality of life 1. The initial treatment options may include open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated) 1.

• Key components of conservative management include:
  • Calf stretches and toe stretches for 10 minutes, 2-3 times daily
  • Night splints to maintain ankle dorsiflexion during sleep
  • Footwear modifications, such as supportive shoes with cushioned soles, and avoiding walking barefoot
  • Over-the-counter arch supports or custom orthotics to redistribute pressure
• For pain management, NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) can be used for 1-2 weeks 1.
• If no improvement occurs after six weeks, referral to a podiatric foot and ankle surgeon is appropriate, and additional treatments may include a customized orthotic device, night splinting, or a limited number of corticosteroid injections 1.
• It is essential to continue initial treatment measures until symptoms resolve, and to consider further options, such as cast immobilization, surgery (plantar fasciotomy), or extracorporeal shock wave therapy, if no improvement occurs after two to three months 1.

From the Research

Management of Plantar Fasciitis

• The management of plantar fasciitis involves various treatment options, including conservative measures and minimally invasive procedures 2, 3.
• Conservative management is considered the first-line treatment and includes the use of plantar insoles, stretching exercises, and corticosteroid injections 2, 3.
• Minimally invasive treatment options, such as platelet-rich plasma (PRP) therapy, are typically reserved for patients who fail conservative management 3, 4.
• PRP therapy has been shown to be effective in reducing pain and improving function in patients with plantar fasciitis, with some studies suggesting it may be more effective than other treatment options, such as corticosteroid injections and extracorporeal shock wave therapy 4, 5.

Treatment Options

• Plantar insoles and stretching exercises have demonstrated limited evidence of benefit, but are often recommended as a first-line treatment due to their low cost and ease of use 2.
• Corticosteroid injections have also demonstrated evidence of benefit, although the effect is often short-lived 2, 5.
• PRP therapy has been shown to be effective in reducing pain and improving function, with some studies suggesting it may be more effective than other treatment options 4, 5.
• Other treatment options, such as extracorporeal shock wave therapy and iontophoresis, may also be effective, but the evidence is limited 2, 3.

Diagnosis and Prognosis

• Plantar fasciitis is a chronic degenerative process that causes medial plantar heel pain, and is responsible for approximately 1 million physician visits each year 6.
• Routine imaging is not initially recommended for the evaluation of plantar fasciitis, but may be required to rule out other pathologic conditions 6.
• Overall, plantar fasciitis carries a good prognosis when patients use a combination of several conservative treatment modalities, and occasionally, referral to a specialist may be necessary 6.