From the Guidelines
Plantar fasciitis treatment should begin with conservative measures, including rest, ice, stretching exercises, and supportive footwear, as these methods have been shown to be effective in reducing symptoms and improving quality of life 1. When treating plantar fasciitis, it is essential to reduce activities that worsen heel pain and apply ice to the painful area for 15-20 minutes, 3-4 times daily.
- Perform calf and plantar fascia stretches several times daily, especially before getting out of bed in the morning.
- Over-the-counter NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (220-440mg twice daily) can help reduce pain and inflammation.
- Supportive footwear with good arch support is essential; avoid walking barefoot.
- Night splints can help maintain a stretched position of the plantar fascia while sleeping.
- For pain relief, consider using heel cups or cushioned insoles. If these measures don't provide relief after 6-8 weeks, it is recommended to see a healthcare provider who might recommend physical therapy, custom orthotics, or in rare cases, surgery 1. Plantar fasciitis occurs when the thick band of tissue connecting your heel to toes becomes inflamed due to repetitive strain, causing microtears in the fascia.
- Most cases resolve with consistent conservative treatment, though recovery may take several months.
- Local injections of corticosteroids are not recommended as an initial treatment option 1.
- In particularly acute or refractory cases, immobilization may be considered.
- If improvement occurs within six to eight weeks, treatments are continued until symptoms resolve 1.
From the Research
Treatment Options for Plantar Fasciitis
- Conservative management is considered the first-line treatment for plantar fasciitis, with approximately 90% of patients responding to non-surgical treatments 2.
- Various physical therapies, such as stretches and shock waves, have been shown to be effective in reducing pain and relieving symptoms of plantar fasciitis, with the best results obtained by combining several techniques 3.
- Minimally invasive treatment options, such as corticosteroid injections, are typically reserved for patients who fail conservative management, but have been shown to be effective in reducing pain and improving function 4, 5, 6.
Effectiveness of Specific Treatments
- Customized functional foot orthoses and corticosteroid injections have both been shown to be effective in reducing pain associated with plantar fasciitis, with orthoses also providing an additional benefit in terms of increased functional ability 5.
- Combining corticosteroid injection with controlled training (strength training and stretching) has been shown to result in a superior effect compared to each treatment separately, and is recommended as first-line treatment in patients with plantar fasciitis 6.
Considerations for Treatment
- The natural history of plantar fasciitis has not been established, making it unclear how much of symptom resolution is due to treatment versus natural resolution of the condition 2.
- Corticosteroid injections may have side effects, such as pain from the injection, which may limit their acceptability 5.
- A combination of causative factors may be present in plantar fasciitis, or the true cause may remain obscure, making treatment challenging 2.