What is the management of plantar fasciitis?

From the Guidelines

The management of plantar fasciitis should primarily involve conservative measures, including the use of 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. When considering the treatment options for plantar fasciitis, it is essential to prioritize methods that reduce pressure on the affected area and promote healing.

• Key components of initial treatment include:
  • The use of open-backed shoes to reduce pressure on the heel 1
  • Heel lifts or orthoses to provide additional support and cushioning
  • NSAIDs to manage pain and inflammation
  • Decreased activity to reduce stress on the plantar fascia
  • Stretching exercises to improve flexibility and reduce tension
  • Weight loss, if indicated, to reduce the mechanical load on the foot According to the American College of Foot and Ankle Surgeons 1, local injections of corticosteroids are not recommended, and immobilization may be considered in acute or refractory cases.
• It is crucial to continue treatments until symptoms resolve, as improvement often occurs within six to eight weeks 1. By focusing on these conservative measures, patients with plantar fasciitis can experience significant improvements in their symptoms and quality of life, reducing the need for more invasive treatments.

From the Research

Management of Plantar Fasciitis

The management of plantar fasciitis typically involves a combination of conservative treatments, with the goal of relieving symptoms and improving function.

• Initial treatment options include:
  • Stretching of the plantar fascia 2
  • Ice massage 2
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) 2, 3, 4
• Other conservative measures that may be effective include:
  • Orthotics and arch supports 5, 4, 6
  • Night splints 5, 4, 6
  • Rest and avoidance of aggravating activities 4
  • Strengthening exercises 4
• For recalcitrant cases, more advanced treatments may be considered, such as:
  • Injections 2, 3, 6
  • Extracorporeal shock wave therapy 2, 6
  • Surgical procedures, including endoscopic fasciotomy 2, 6

Treatment Outcomes

The majority of patients with plantar fasciitis can expect to improve with conservative treatment, with reported success rates ranging from 80% to 90% 2, 5, 3, 6. However, some patients may require more prolonged treatment or advanced interventions to achieve symptom relief.

• It is essential to individualize treatment approaches based on the underlying causes and contributing factors, such as biomechanical abnormalities, anatomical variations, and environmental factors 5, 3, 4.