From the Guidelines
Treatment for plantar fasciitis should begin with conservative approaches, including open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss, as these methods have been shown to be effective in reducing symptoms and improving quality of life. The initial treatment options may include 1:
- Open-backed shoes to reduce pressure on the area
- Heel lifts or orthoses to provide support and cushioning
- NSAIDs to manage pain and inflammation
- Decreased activity to reduce strain on the plantar fascia
- Stretching exercises to promote tissue healing and flexibility
- Weight loss, if indicated, to reduce pressure on the plantar fascia
It is essential to note that local injections of corticosteroids are not recommended as an initial treatment option 1. However, if no improvement occurs after six weeks, referral to a podiatric foot and ankle surgeon is appropriate, and additional treatments may include a customized orthotic device, night splinting, or a limited number of corticosteroid injections 1.
In cases where symptoms persist, further options may include cast immobilization, surgery (plantar fasciotomy), or extracorporeal shock wave therapy 1. It is crucial to continue initial treatment measures until symptoms resolve and to explore other diagnoses if no improvement occurs after two to three months 1.
Overall, the goal of treatment is to reduce inflammation, promote tissue healing, and correct biomechanical issues that contribute to excessive strain on the plantar fascia, ultimately improving morbidity, mortality, and quality of life.
From the Research
Treatment Options for Plantar Fasciitis
The treatment of plantar fasciitis can be divided into conservative and surgical methods. Conservative treatments are the first line of treatment and are effective in approximately 90% of patients 2, 3.
- Conservative Treatments:
- Patient-directed treatments such as rest, activity modification, ice massage, oral analgesics, and stretching techniques can be tried for several weeks 2.
- Physician-prescribed treatments including physical therapy modalities, foot orthotics, night splinting, and corticosteroid injections can be considered if heel pain persists 2.
- Platelet-rich plasma (PRP) therapy has demonstrated effectiveness in reducing pain and improving function in patients with plantar fasciitis, with some studies showing it to be more effective than other conservative treatments such as extracorporeal shock wave therapy (ESWT) and corticosteroid injections 4, 5.
- Custom orthotics and stretching exercises focused on the plantar fascia have also shown limited evidence of benefit 6.
Comparison of Treatment Modalities
Studies have compared the effectiveness of different conservative treatment options for plantar fasciitis.
- PRP vs. ESWT: PRP has been shown to be more effective than ESWT in reducing pain and improving function in some studies 4, 5.
- PRP vs. Corticosteroid Injections: PRP has been shown to be more effective than corticosteroid injections in reducing pain and improving function in some studies 4.
- ESWT vs. Other Treatments: ESWT has been shown to be effective in reducing pain and improving function, but its effectiveness compared to other treatments such as PRP and custom orthotics is still debated 5.
Surgical Treatment
Surgical treatment, such as plantar fasciotomy, is considered for patients with chronic recalcitrant plantar fasciitis lasting six months or longer 2. However, surgical treatment is not commonly used and is typically reserved for cases where conservative treatments have failed.