From the Guidelines
The most effective treatment for plantar fasciitis involves a combination of conservative measures, including rest, stretching exercises, and orthoses, as recommended by the American College of Foot and Ankle Surgeons 1. When treating plantar fasciitis, it is essential to prioritize measures that reduce pressure on the affected area and promote healing.
- Initial treatment options may 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 promote flexibility and healing
- Weight loss, if indicated, to reduce strain on the plantar fascia
- Local injections of corticosteroids are not recommended as a first-line treatment 1.
- In cases where symptoms persist or worsen, immobilization may be considered to allow the affected tissue to heal.
- It is crucial to continue treatment for at least six to eight weeks to assess the effectiveness of the chosen interventions and adjust the treatment plan as needed 1.
- By following this approach, most cases of plantar fasciitis can be effectively managed, and symptoms can be significantly reduced or resolved.
From the Research
Treatment Options for Plantar Fasciitis
- The treatment for plantar fasciitis should start with stretching of the plantar fascia, ice massage, and nonsteroidal anti-inflammatory drugs 2.
- Conservative management is considered the first-line treatment, and it has been shown to be effective in approximately 80-90% of patients 2, 3, 4.
- Minimally invasive treatment options, such as injections, extracorporeal shock wave therapy, or surgical procedures, can be considered for recalcitrant plantar fasciitis 2, 4, 5.
Conservative Management
- Stretching exercises focused on the plantar fascia have demonstrated limited evidence of benefit 6.
- The use of plantar insoles has also demonstrated limited evidence of benefit 6.
- Corticosteroid injections and iontophoresis with steroids have shown evidence of benefit, although limited and during a short time 6.
Minimally Invasive Treatment Options
- Extracorporeal shock wave therapy (ESWT) has been found to perform significantly better than placebo for pain score and function 5.
- ESWT has been proven to be a successful treatment for plantar fasciitis, but platelet-rich plasma (PRP) showed a statistically and clinically significant greater improvement in pain and function than ESWT 5.
- Custom orthotics have been found to improve function significantly over ESWT 5.