From the Guidelines
For plantar fasciitis, I recommend a comprehensive treatment plan including rest, ice, stretching exercises, and NSAIDs, as outlined in the American College of Foot and Ankle Surgeons guidelines 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. Some key points to consider in the treatment plan are:
- Decreasing activity to reduce stress on the plantar fascia
- Using NSAIDs to reduce inflammation, as recommended by the American College of Foot and Ankle Surgeons 1
- Performing stretching exercises to improve flexibility and reduce tension on the plantar fascia
- Using orthoses or heel lifts to reduce pressure on the affected area
- Considering weight loss if the patient is overweight or obese, as this can reduce stress on the plantar fascia 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 corticosteroid injections 1. It's essential to continue initial treatment measures until symptoms resolve, and to explore other diagnoses if no improvement occurs after two to three months 1. In terms of specific treatment protocols, the use of NSAIDs like ibuprofen 400-600mg three times daily for 1-2 weeks can help reduce inflammation, and applying ice to the affected area for 15-20 minutes, 3-4 times daily can help reduce pain and inflammation. Additionally, performing calf and plantar fascia stretches 3 times daily, holding each stretch for 30 seconds and repeating 10 times, can help improve flexibility and reduce tension on the plantar fascia. Night splints can be worn to maintain ankle dorsiflexion during sleep, and supportive footwear with good arch support is essential, with custom orthotics may be beneficial for those with significant foot mechanics issues 1.
From the Research
Dot Phrase Plan for Plantar Fasciitis
- Plantar fasciitis is a common problem that can be treated with various methods, including stretching, ice massage, and nonsteroidal anti-inflammatory drugs 2
- The condition is not inflammatory, and risk factors include limited ankle dorsiflexion, increased body mass index, and standing for prolonged periods of time 2
- Symptoms of plantar fasciitis include stabbing, nonradiating pain in the proximal medioplantar surface of the foot, which becomes worse at the end of the day 2
- Treatment options for plantar fasciitis include:
- Stretching of the plantar fascia and Achilles tendon 3, 4
- Ice massage 2, 3
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 2, 3
- Orthotics, including prefabricated and custom-fitted orthotics 5
- Extracorporeal shock wave therapy (ESWT) 6
- Corticosteroid injections (CSs) 6
- Platelet-rich plasma (PRP) 6
- Botulinum toxin A (BTX-A) 6
- Dry needling (DN) 6
- A study found that ESWT was the most effective treatment for plantar fasciitis, followed by BTX-A and PRP 6
- Another study found that orthotics, both prefabricated and custom-fitted, can reduce pain and improve function in adults with acute plantar fasciitis 5
- A clinical trial found that a plantar fascia-stretching protocol improved outcomes in patients with chronic plantar fasciitis, with marked improvement in pain and functional limitations 4