Is ultrasound therapy effective for treating plantar fasciitis?

Effectiveness of Ultrasound Therapy for Plantar Fasciitis

Therapeutic ultrasound is not recommended as a primary treatment for plantar fasciitis due to weak evidence supporting its effectiveness. 1

Evidence Assessment

The American College of Foot and Ankle Surgeons guidelines do not include therapeutic ultrasound in their recommended treatment protocol for plantar fasciitis 1. Instead, they emphasize:

• Initial treatments:

  • Regular calf-muscle stretching
  • Cryotherapy
  • Over-the-counter heel cushions and arch supports
  • Weight loss (if indicated)
  • Activity limitation
  • Avoiding flat shoes and barefoot walking
  • NSAIDs
  • Padding and strapping of the foot
  • Corticosteroid injections in appropriate patients

• Secondary treatments (if no improvement after 6 weeks):

  • Customized orthotic devices
  • Night splinting
  • Limited corticosteroid injections
  • Casting or fixed-ankle walker-type devices
  • Extracorporeal shock wave therapy (ESWT)
  • Surgery (plantar fasciotomy) as a last resort

According to the American Family Physician guidelines, therapeutic ultrasound produces high-frequency vibrations that generate heat in superficial tissues and may decrease pain and increase collagen synthesis. However, the evidence for consistent benefit in tendinopathies, including plantar fasciitis, is weak 1.

Diagnostic Considerations

For diagnostic purposes, ultrasound imaging (not to be confused with therapeutic ultrasound) has shown good sensitivity (80%) and specificity (88%) in diagnosing plantar fasciitis when compared to MRI 1. High-resolution ultrasound is becoming a standard imaging technique for assessing plantar fasciitis, with major findings including increased plantar fascia thickness and hypoechoic changes 2.

More Effective Treatment Options

Recent evidence suggests that more effective treatments for plantar fasciitis include:

1. Stretching exercises (plantar fascia-specific and calf stretching) 3
2. Appropriate orthotics 3
3. Night dorsiflexion splinting 3
4. Extracorporeal shock wave therapy (ESWT) for chronic cases 3

Treatment Algorithm

1. First-line treatments (0-6 weeks):

   • Plantar fascia and calf stretching exercises
   • Activity modification
   • Over-the-counter heel cushions/arch supports
   • NSAIDs
   • Ice massage
   • Proper footwear

2. Second-line treatments (if no improvement after 6 weeks):

   • Custom orthotics
   • Night splinting
   • Physical therapy (not primarily ultrasound)
   • Corticosteroid injections (limited use)

3. Refractory cases (after 3-6 months of conservative treatment):

   • Extracorporeal shock wave therapy (ESWT)
   • Consideration for surgical options (plantar fasciotomy)

Pitfalls and Caveats

• Therapeutic ultrasound should not be relied upon as a primary treatment modality due to weak supporting evidence 1
• Corticosteroid injections provide only temporary relief and may increase risk of plantar fascia rupture and fat pad atrophy 4
• Treatment of plantar fasciitis typically requires patience, as resolution can take 3-6 months even with appropriate therapy 4
• Diagnostic ultrasound should not be confused with therapeutic ultrasound—the former is useful for diagnosis while the latter has limited evidence for treatment

In conclusion, while therapeutic ultrasound is sometimes used in clinical practice for plantar fasciitis, current guidelines and evidence do not strongly support its effectiveness as a primary treatment option.