From the Guidelines
Management of plantar fasciitis should begin with conservative measures, including open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss, as these measures have been shown to improve symptoms and quality of life. According to the American College of Foot and Ankle Surgeons 1, initial treatment options may include these conservative measures. Key components of the treatment plan include:
- Open-backed shoes to reduce pressure on the area
- Heel lifts or orthoses to provide additional support
- NSAIDs to reduce pain and inflammation
- Decreased activity to avoid exacerbating the condition
- Stretching exercises to improve flexibility and reduce tension
- Weight loss, if indicated, to reduce pressure on the plantar fascia It is essential to note that local injections of corticosteroids are not recommended initially 1. 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. In cases where conservative measures fail, further options, including surgery or extracorporeal shock wave therapy, may be explored. Overall, the goal of treatment is to reduce symptoms, improve quality of life, and minimize the risk of complications, such as fascia rupture.
From the Research
Management of Plantar Fasciitis
- The management of plantar fasciitis typically involves a combination of conservative therapies, including rest, ice massage, stretching of the Achilles tendon and plantar fascia, nonsteroidal anti-inflammatory medications (NSAIDs), corticosteroid injections, foot padding, taping, shoe modifications, arch supports, heel cups, custom foot orthoses, night splints, ultrasound, and casting 2.
- Stretching of the plantar fascia, ice massage, and nonsteroidal anti-inflammatory drugs are often recommended as initial treatments 3.
- Many standard treatments, such as night splints and orthoses, have not shown benefit over placebo 3.
- Recalcitrant plantar fasciitis can be treated with injections, extracorporeal shock wave therapy, or surgical procedures, although evidence is lacking 3.
- Noninvasive interactive neurostimulation (NIN) has been shown to be an effective treatment for chronic plantar fasciitis, with significant improvements in foot functional score, pain levels, and patient satisfaction compared to electric shockwave therapy 4.
Treatment Outcomes
- Nonsurgical management of plantar fasciitis is successful in approximately 90% of patients 5, 6.
- With proper treatment, 80% of patients with plantar fasciitis improve within 12 months 3.
- The use of oral NSAIDs in combination with a conservative treatment regimen may increase pain relief and decrease disability in patients with plantar fasciitis 2.
Diagnostic Considerations
- Plantar fasciitis is predominantly a clinical diagnosis, with symptoms including stabbing, nonradiating pain in the proximal medioplantar surface of the foot 3.
- Ultrasonography is a reasonable and inexpensive diagnostic tool for patients with pain that persists beyond three months despite treatment 3.
- A comprehensive history and physical examination are important for guiding accurate diagnosis and ruling out other causes of plantar heel pain 6.