From the Guidelines
Plantar fasciitis treatment should prioritize a combination of rest, stretching exercises, and supportive footwear, with NSAIDs and orthoses as initial treatment options, as recommended by the American College of Foot and Ankle Surgeons 1. The initial treatment approach for plantar fasciitis includes reducing activities that worsen heel pain, applying ice to the affected area, and performing calf and plantar fascia stretches several times daily.
- Key treatment options include:
- Open-backed shoes to reduce pressure on the area
- Heel lifts or orthoses
- NSAIDs for pain and inflammation management
- Decreased activity
- Stretching exercises
- Weight loss, if indicated According to the American College of Foot and Ankle Surgeons, if 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 essential to continue initial treatment measures until symptoms resolve, and if no improvement occurs after two to three months, further options, including surgery or extracorporeal shock wave therapy, may be explored 1.
From the Research
Treatment Options for Plantar Fasciitis
- Plantar fasciitis is a common cause of heel pain, and its treatment can be challenging due to its resistance to various therapies 2.
- Conservative management is the primary approach, with approximately 90% of patients responding to non-surgical treatments 2.
- Various physical therapies, such as stretches and shock waves, have been used to treat plantar fasciitis, with the best results often obtained by combining several techniques 3.
Effectiveness of Different Treatments
- Customized functional foot orthoses and corticosteroid injections are two commonly used treatments for plantar fasciitis, both of which can lead to a decrease in pain associated with the condition 4.
- Orthotics, including prefabricated and custom-fitted options, have been shown to reduce pain and improve function in adults with acute plantar fasciitis 5.
- Combining corticosteroid injection with controlled training, such as strength training and stretching, has been found to be the most effective treatment for plantar fasciitis, resulting in superior outcomes compared to each treatment alone 6.
Recommendations for Treatment
- The combination of corticosteroid injections and training (strength training and stretching) is recommended as the first-line treatment for patients with plantar fasciitis 6.
- Orthotics, either prefabricated or custom-fitted, can be used alone or in addition to conventional therapy to reduce pain and improve function in adults with acute plantar fasciitis 5.
- Physical therapies, such as stretches and shock waves, can be effective in reducing pain and relieving symptoms of plantar fasciitis, especially when combined with other treatments 3.