From the Guidelines
Plantar fasciitis is best diagnosed and treated with a combination of weightbearing radiographs, physical examination, and conservative measures including rest, ice application, stretching exercises, and supportive footwear, as evidenced by the most recent study 1. The diagnosis of plantar fasciitis involves a physical examination revealing tenderness at the medial heel and sometimes along the plantar fascia, with pain worsening during dorsiflexion of the toes. Some key points to consider in the diagnosis and treatment of plantar fasciitis include:
- Weightbearing radiographs are the initial imaging study of choice, with a sensitivity of 85% and a specificity of 95% for plantar fasciitis 1
- Conservative measures such as rest, ice application for 15-20 minutes several times daily, and stretching exercises targeting the plantar fascia and Achilles tendon are recommended
- Patients should perform calf stretches and plantar fascia-specific stretches by pulling the toes toward the shin 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 reduce pain and inflammation
- Supportive footwear with cushioned heels and arch support is essential, and night splints that keep the foot dorsiflexed during sleep can prevent morning pain
- Custom or over-the-counter orthotic inserts can provide additional arch support
- For persistent cases, physical therapy, corticosteroid injections, or extracorporeal shock wave therapy may be considered, as suggested by earlier studies 1 It is worth noting that most cases of plantar fasciitis resolve within 6-12 months with conservative treatment, though recurrence is common without ongoing preventive measures like maintaining appropriate footwear and regular stretching.
From the Research
Diagnosis of Plantar Fasciitis
- Plantar fasciitis is primarily diagnosed based on history and physical examination 2, 3
- Symptoms include heel pain with first steps in the morning or after prolonged sitting, and sharp pain with palpation of the medial plantar calcaneal region 2
- Diagnostic imaging such as ultrasonography and magnetic resonance imaging is rarely needed for initial diagnosis, but can be used for recalcitrant cases or to rule out other heel pathology 2, 3
- Physical examination findings are often limited to tenderness to palpation of the proximal plantar fascial insertion at the anteromedial calcaneus 3
Treatment Options for Plantar Fasciitis
- Conservative treatments include rest, activity modification, ice massage, oral analgesics, and stretching techniques 2, 4, 5
- 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
- Ninety percent of patients will improve with conservative techniques 2, 6
- Recalcitrant plantar fasciitis can be treated with injections, extracorporeal shock wave therapy, or surgical procedures such as endoscopic fasciotomy 2, 3, 5
- Oral nonsteroidal anti-inflammatory medications (NSAIDs) may increase pain relief and decrease disability in patients with plantar fasciitis when used with a conservative treatment regimen 4
Risk Factors and Prevention
- Risk factors for developing plantar fasciitis include obesity, excessive foot pronation, excessive running, and prolonged standing 2, 3
- Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality 5
- Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics, and night dorsiflexion splinting, can alleviate plantar fascia pain 5