What are the treatment options for plantar fasciitis?

From the Guidelines

Plantar fasciitis treatment should initially focus on conservative measures, including the use of open-backed shoes, orthoses, accommodative padding, NSAID therapy, and physical therapy, as these methods have been shown to be effective in managing symptoms 1. When treating plantar fasciitis, it is essential to consider the following key components:

• Initial treatment options: open-backed shoes, orthoses, accommodative padding, NSAID therapy, and physical therapy
• If symptoms improve, continue initial treatments
• If symptoms do not improve within six to eight weeks, consider other diagnoses and refer to a podiatric foot and ankle surgeon
• Additional treatment options: immobilization cast or fixed-ankle walker-type device, bursa injection, and surgical procedures such as resection of the prominent posterior superior aspect of the calcaneus and inflamed bursa, or calcaneal osteotomy to correct calcaneal alignment 1 Key considerations in treatment include:
• Avoiding the Achilles tendon when administering corticosteroid injections
• Weight loss, if indicated, to reduce stress on the plantar fascia
• The potential for neurologic heel pain due to irritation or entrapment of nerves innervating the heel, which may require separate evaluation and treatment 1 It is crucial to prioritize a multidisciplinary approach, incorporating both non-pharmacological and pharmacological interventions, to optimize treatment outcomes and minimize the risk of complications or prolonged morbidity.

From the Research

Treatment Options for Plantar Fasciitis

• Conservative treatments are often recommended as the initial approach for managing plantar fasciitis, including rest, activity modification, ice massage, oral analgesics, and stretching techniques 2
• Physical therapy modalities, foot orthotics, night splinting, and corticosteroid injections may be considered if heel pain persists 2
• Oral nonsteroidal anti-inflammatory medications (NSAIDs) may provide some benefit in reducing pain and disability when used in conjunction with conservative treatments 3
• The use of plantar insoles and stretching exercises focused on the plantar fascia have demonstrated limited evidence of benefit 4
• Corticosteroid injections and iontophoresis with steroids have also demonstrated evidence of benefit, although limited and short-term 4

Combination Therapies

• Combining corticosteroid injection with controlled training (strength training and stretching) has been shown to result in a superior effect compared to each treatment separately 5
• This combined treatment approach is recommended as the first line of treatment for patients with plantar fasciitis, as it has been found to be superior in both the short- and long-term 5

Treatment Efficacy

• Approximately 90% of patients with plantar fasciitis will improve with conservative techniques 2, 6
• The natural history of plantar fasciitis has not been established, making it unclear how much of symptom resolution is due to treatment versus the natural course of the condition 6
• There is no single universally accepted treatment for plantar fasciitis, and the efficacy of various treatments can vary 3, 4