What is the best treatment plan for a 45-year-old male patient with plantar fasciitis?

Treatment Plan for Plantar Fasciitis

For a 45-year-old male patient with plantar fasciitis, provide custom orthotic insoles (Apex X520M and gel insoles size 9.0) along with diclofenac cream for pain management. This combination of mechanical offloading and topical anti-inflammatory medication represents an evidence-based approach to treating plantar fasciitis.

First-Line Treatment Components

1. Appropriate Footwear and Orthotic Support

• Custom orthotic insoles (Apex X520M with gel insoles) are indicated to provide proper arch support and pressure redistribution
• Properly fitting footwear is essential for patients with plantar fasciitis to prevent further irritation 1
• The internal width of shoes should equal the width of the foot at the metatarsal phalangeal joints, and height should allow enough room for all toes 1
• Therapeutic footwear should have demonstrated plantar pressure-relieving effect (30% relief compared with standard footwear) 1

2. Topical Anti-inflammatory Medication

• Diclofenac cream is appropriate for localized pain management 2
• Application instructions:
  • Apply 4 times daily for best results
  • Use on clean, dry skin
  • Gently rub into the affected area
  • Wash hands after application
  • Avoid covering treated area for at least 10 minutes after application

3. Stretching and Home Care Instructions

• Instruct patient to perform plantar fascia stretching exercises daily 3, 4
• Ice massage to affected area for 5-10 minutes, especially after long periods of standing 3
• Activity modification to reduce prolonged standing when possible 3

Monitoring and Follow-up

• Schedule follow-up in 4-6 weeks to assess response to treatment
• If no improvement after 6-12 weeks of conservative treatment, consider:
  • Ultrasound evaluation to confirm diagnosis and assess plantar fascia thickness 5
  • Possible referral for physical therapy modalities
  • Consideration of night splints for recalcitrant cases 4

Cautions and Contraindications

For Diclofenac Cream:

• Monitor for skin irritation or allergic reactions
• Avoid use if patient has:
  • History of allergic reactions to NSAIDs
  • Severe heart, liver, or kidney disease
  • Recent heart surgery 2
• Advise patient not to use more than directed or for longer than directed due to potential liver damage 2
• Not recommended for use with heating pads or occlusive dressings

For Orthotic Devices:

• Ensure proper fit to avoid creating new pressure points
• Gradually increase wearing time to allow adaptation
• Replace insoles when they show signs of wear

Expected Outcomes

With proper treatment adherence, approximately 80% of patients with plantar fasciitis improve within 12 months 3. The combination of mechanical offloading through proper footwear and orthotic support, along with pain management using topical diclofenac, addresses both the mechanical factors and pain symptoms associated with plantar fasciitis.