From the Guidelines
The recommended treatment for plantar fasciitis begins with conservative measures, including rest, ice application, and stretching exercises targeting the plantar fascia and Achilles tendon, as supported by the most recent and highest quality study 1.
Key Components of Treatment
- Patients should perform calf stretches and toe stretches for 30 seconds, repeated 3-5 times, several times daily.
- 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.
- Proper footwear with good arch support is essential, and custom or over-the-counter orthotic inserts can provide additional support.
- Night splints that keep the foot dorsiflexed during sleep help prevent morning pain by maintaining a gentle stretch.
Additional Considerations
- For persistent cases, physical therapy focusing on strengthening and stretching exercises may be beneficial.
- Corticosteroid injections (typically using betamethasone or methylprednisolone mixed with lidocaine) can provide temporary relief but should be limited to 2-3 injections due to risk of fascia rupture.
- Most cases resolve within 6-12 months with consistent conservative treatment.
Rationale
These approaches work by reducing inflammation, promoting tissue healing, and addressing biomechanical factors that contribute to excessive strain on the plantar fascia, as outlined in the guidelines on the prevention of foot ulcers in persons with diabetes 1.
Important Note
While the provided evidence includes various studies on foot ulcers and diabetes, the most relevant and recent guideline for treating plantar fasciitis is focused on conservative management and orthotic interventions 1.
From the Research
Treatment Options for Plantar Fasciitis
- The recommended treatment for plantar fasciitis includes a combination of conservative treatments such as rest, activity modification, ice massage, oral analgesics, and stretching techniques 2, 3, 4.
- Patient-directed treatments can be tried for several weeks, and if heel pain persists, physician-prescribed treatments such as physical therapy modalities, foot orthotics, night splinting, and corticosteroid injections can be considered 2.
- Orthotics, both prefabricated and custom fitted, have been shown to reduce pain and improve function in adults with acute plantar fasciitis, and can be used alone or in addition to conventional therapy 5.
- A multimodal strategy including manual therapy, strengthening and stretching exercises, as well as patient education and counselling on self-management techniques can also be effective in treating plantar fasciitis 6.
- In cases of chronic recalcitrant plantar fasciitis, extracorporeal shock wave therapy or plantar fasciotomy may be considered 2, 4.
Conservative Treatments
- Rest, activity modification, and ice massage can help alleviate symptoms of plantar fasciitis 2, 3, 4.
- Oral analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to manage pain 2, 3, 4.
- Stretching techniques, including stretching of the plantar fascia, can help improve symptoms 2, 4.
- Physical therapy modalities, such as ultrasound and electrical stimulation, can also be used to treat plantar fasciitis 2.
Advanced Treatments
- Corticosteroid injections can be used to reduce inflammation and relieve pain in cases of persistent plantar fasciitis 2, 3.
- Extracorporeal shock wave therapy can be used to treat chronic recalcitrant plantar fasciitis 2, 4.
- Plantar fasciotomy, a surgical procedure that involves releasing the plantar fascia, can be considered in cases of severe, persistent plantar fasciitis 2, 4.