From the Guidelines
To treat plantar fasciitis, initial treatment options should include open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated) as recommended by the American College of Foot and Ankle Surgeons 1. When managing plantar fasciitis, it's essential to prioritize conservative measures to reduce morbidity, mortality, and improve quality of life.
- Key treatment strategies include:
- Wearing open-backed shoes to reduce pressure on the affected area
- Using heel lifts or orthoses to provide additional support
- Taking NSAIDs to alleviate pain and inflammation
- Decreasing activity to avoid exacerbating the condition
- Performing stretching exercises to promote healing and flexibility
- Losing weight, if indicated, to reduce strain on the plantar fascia If symptoms persist beyond 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's crucial to note that local injections of corticosteroids are not recommended as an initial treatment option 1, and surgery should only be considered in rare cases where other treatments have failed.
- Further treatment options may include:
- Casting or use of a fixed-ankle walker-type device during activity
- Extracorporeal shock wave therapy
- Exploring other diagnoses if symptoms persist or worsen over time By following these guidelines and prioritizing conservative measures, patients with plantar fasciitis can experience significant improvements in symptoms and quality of life, while minimizing the risk of complications and morbidity.
From the Research
Treatment Options for Plantar Fasciitis
- Conservative treatments are often recommended as the initial approach to manage plantar fasciitis, with studies suggesting that 80-90% of patients improve within 12 months 2, 3, 4.
- Patient-directed treatments may include:
- Physician-prescribed treatments may be considered if heel pain persists, and may include:
- Physical therapy modalities
- Foot orthotics
- Night splinting
- Corticosteroid injections, which have shown limited evidence of benefit, but may be useful in some cases 3, 6
- Extracorporeal shock wave therapy, which has been shown to be effective in some studies, particularly when other techniques have failed 5
Advanced Treatment Options
- For patients with chronic recalcitrant plantar fasciitis, options may include:
- Extracorporeal shock wave therapy
- Plantar fasciotomy, which may be considered in patients who have not responded to conservative treatment options 2, 3
- Endoscopic fasciotomy, which may be required in patients who continue to have pain that limits activity and function despite exhausting nonoperative treatment options 3
Diagnostic Considerations
- Diagnosis of plantar fasciitis is primarily based on history and physical examination, with diagnostic imaging rarely needed for initial diagnosis 2, 3.
- Ultrasonography and magnetic resonance imaging may be reserved for recalcitrant cases or to rule out other heel pathology, with findings of increased plantar fascia thickness and abnormal tissue signal indicating the diagnosis of plantar fasciitis 2.