From the Guidelines
Plantar fasciitis treatment should begin with conservative measures, including rest, ice, and stretching exercises, as well as the use of open-backed shoes, orthoses, and NSAIDs, while avoiding local injections of corticosteroids, 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 support and cushioning
- NSAIDs to manage pain and inflammation
- Decreased activity to avoid exacerbating the condition
- Stretching exercises to improve flexibility and reduce tension in the plantar fascia
- Weight loss, if indicated, to reduce the strain on the foot
Persistent Cases
For persistent cases of plantar fasciitis, additional treatments may be considered, such as:
- Physical therapy focusing on strengthening and stretching
- Customized orthotic devices to provide additional support and cushioning
- Night splints to keep the foot dorsiflexed during sleep and prevent morning pain
- Casting or use of a fixed-ankle walker-type device during activity to immobilize the foot and promote healing
Medical Interventions
If symptoms do not improve after 6-12 weeks, medical interventions like corticosteroid injections, extracorporeal shock wave therapy, or in rare cases, surgery may be considered, as recommended by the American College of Foot and Ankle Surgeons 1. These treatments work by reducing inflammation in the plantar fascia, strengthening supporting muscles, and promoting proper biomechanics to allow the fascia to heal.
From the Research
Treatment Options for Plantar Fasciitis
- Conservative treatment is often the first line of treatment for plantar fasciitis, with options including nonsteroidal anti-inflammatory drugs, rest, pads, cups, splints, orthotics, corticosteroid injections, casts, physical therapy, ice, and heat 2
- A study comparing the effectiveness of full-length silicone insoles and ultrasound-guided corticosteroid injection found that both treatments were effective, but the injection group showed better results in terms of pain reduction and plantar fascia thickness 3
- Combining corticosteroid injection with controlled training (strength training and stretching) has been shown to be a superior treatment option, with significant improvements in pain and function at 6 months 4
- Physical therapies such as stretches and shock waves can be effective in reducing pain and relieving symptoms of plantar fasciitis, with the best results often obtained by combining several techniques 5
Recommendations for Treatment
- The use of silicone insoles is recommended as a first line of treatment for persons with plantar fasciitis 3
- Corticosteroid injections combined with controlled training are recommended as a first line treatment in patients with plantar fasciitis 4
- Treatment of plantar fasciitis is patient dependent and commonly requires a combination of different modalities to successfully alleviate the symptoms 6
Effectiveness of Treatment
- Conservative treatment is ultimately effective in approximately 90% of patients with plantar fasciitis 2
- The combination of corticosteroid injection and training (strength training and stretching) has been shown to have a superior effect compared to each treatment separately 4
- Physical therapies used in the treatment of plantar fasciitis have proven effective to varying degrees in reducing pain and relieving symptoms 5