From the Guidelines
Treatment for plantar fasciitis should begin with conservative measures, including rest, ice application, stretching exercises, and NSAIDs, as these methods have been shown to reduce pain and inflammation in the plantar fascia. According to the American College of Foot and Ankle Surgeons 1, initial treatment options may include open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated).
- Key treatment components include:
- Rest and ice application to reduce inflammation
- Stretching exercises for the plantar fascia and Achilles tendon, such as calf stretches and toe stretches, several times daily
- Over-the-counter NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (220-440mg twice daily) to reduce pain and inflammation
- Wearing supportive shoes with good arch support and cushioning
- Night splints to maintain ankle dorsiflexion during sleep and prevent morning pain
- Custom or over-the-counter orthotic inserts for additional support
- For persistent cases, physical therapy focusing on strengthening and stretching exercises is beneficial, and corticosteroid injections may provide temporary relief, but should be limited to 2-3 injections per year 1.
- 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 use of a fixed-ankle walker-type device during activity 1.
- Most cases resolve within 6-12 months with consistent conservative treatment.
From the Research
Treatment Options for Plantar Fasciitis
- Conservative therapies are commonly used to treat plantar fasciitis, including rest, ice massage, stretching of the Achilles tendon and plantar fascia, nonsteroidal anti-inflammatory medications (NSAIDs), corticosteroid injections, foot padding, taping, shoe modifications, arch supports, heel cups, custom foot orthoses, night splints, ultrasound, and casting 2
- Supportive treatments such as plantar fascia-specific stretch, calf stretching, appropriate orthotics, and night dorsiflexion splinting can alleviate plantar fascia pain 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 3
- Treatment should start with stretching of the plantar fascia, ice massage, and nonsteroidal anti-inflammatory drugs 4
- Recalcitrant plantar fasciitis can be treated with injections, extracorporeal shock wave therapy, or surgical procedures, although evidence is lacking 4
- A combination of causative factors may be present, or the true cause may remain obscure, and although normally managed with conservative treatment, plantar fasciitis is frequently resistant to the wide variety of treatments commonly used 5
- Many treatment options exist, including rest, stretching, strengthening, change of shoes, arch supports, orthotics, night splints, anti-inflammatory agents and surgery 6
Efficacy of Treatment Options
- Pain and disability mean scores improved significantly over time in both placebo and NSAID groups, although there was no statistical significance between the groups at 1,2, or 6 months 2
- There was a trend towards improved pain relief and disability in the NSAID group, especially in the interval between the 2 and 6-month followup 2
- Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis 3
- With proper treatment, 80% of patients with plantar fasciitis improve within 12 months 4
- Nonsurgical treatment is ultimately effective in approximately 90% of patients 5