From the Guidelines
The plan of care for plantar fasciitis should begin with conservative management, including initial treatment options such as open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss, as recommended by the American College of Foot and Ankle Surgeons 1.
Key Components of Conservative Management
- Activity modification to reduce weight-bearing stress on the affected foot
- Pain relief with NSAIDs, such as ibuprofen or naproxen, for short courses of 1-2 weeks
- Daily stretching program focusing on the plantar fascia, Achilles tendon, and calf muscles
- Proper footwear with adequate arch support and cushioning, and custom or over-the-counter orthotic inserts for additional support
- Night splints to maintain ankle dorsiflexion during sleep and prevent morning pain
Additional Treatment Options
- Referral to a podiatric foot and ankle surgeon if no improvement occurs after six weeks, for consideration of customized orthotic devices, night splinting, corticosteroid injections, casting, or use of a fixed-ankle walker-type device during activity 1
- Extracorporeal shock wave therapy for chronic cases
- Surgery, such as plantar fasciotomy, reserved for cases unresponsive to 6-12 months of conservative treatment
Important Considerations
- Local injections of corticosteroids are not recommended as initial treatment 1
- Immobilization may be considered in particularly acute or refractory cases
- Treatment should continue until symptoms resolve, with regular reassessment and adjustment of the treatment plan as needed 1
From the Research
Plan of Care for Plantar Fasciitis
The plan of care for plantar fasciitis typically involves a combination of conservative therapies, including:
- Rest, ice massage, and stretching of the Achilles tendon and plantar fascia 2
- Nonsteroidal anti-inflammatory medications (NSAIDs) 2
- Corticosteroid injections 3, 4
- Foot padding, taping, shoe modifications, arch supports, heel cups, custom foot orthoses, and night splints 2, 4
- Ultrasound and casting 2
- Strength training and stretching 3
- Activity modification to decrease cyclical repetitive loading of the plantar fascia 4
Treatment Options
Treatment options for plantar fasciitis can be categorized into:
- Conservative treatments, such as stretching, ice massage, and NSAIDs, which are often the first line of treatment 2, 5
- Injectable treatments, such as corticosteroid injections, which can provide short-term pain relief 3, 4
- Advanced treatments, such as extracorporeal shock wave therapy or surgical procedures, which may be considered for recalcitrant cases 4, 5
Recommendations
Recommendations for the treatment of plantar fasciitis include:
- Combining corticosteroid injections with controlled training, such as strength training and stretching, for superior results 3
- Using a combination of conservative therapies, such as rest, ice massage, and stretching, to alleviate symptoms 2, 4
- Considering ultrasonography-guided focal extracorporeal shock wave therapy for patients with chronic plantar fasciitis 4
- Advising activity modification to decrease cyclical repetitive loading of the plantar fascia during the treatment phase 4