What NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) can be given for plantar fasciitis?

NSAIDs for Plantar Fasciitis

Oral NSAIDs such as naproxen, ibuprofen, diclofenac, and celecoxib are recommended as first-line pharmacological treatment for plantar fasciitis, to be used at maximum tolerated dosages for 1-2 weeks.

First-Line NSAID Options

Oral NSAIDs that can be considered for plantar fasciitis include:

• Naproxen: 375-1100 mg/day in two doses 1
• Diclofenac: Starting at 150 mg/day in divided doses, maintenance 75-100 mg/day 1
• Ibuprofen: 1800 mg/day in divided doses 1
• Celecoxib: 200-400 mg/day in divided doses 1
• Meloxicam: 15 mg/day in one dose 1

Treatment Algorithm

1. Initial Treatment (0-2 weeks):

   • Start with maximum tolerated dose of oral NSAIDs 2, 3
   • Combine with plantar fascia stretching and ice massage 3
   • If first NSAID is ineffective or not tolerated, try another NSAID 2

2. Follow-up at 2-4 weeks:

   • If sufficient response: Continue treatment and consider tapering 1
   • If insufficient response: Consider alternative or additional treatments 1

3. For persistent symptoms (beyond 4-6 weeks):

   • Consider topical NSAIDs which have fewer systemic side effects 2
   • Consider other interventions such as corticosteroid injections 3

Evidence for Efficacy

Research shows that NSAIDs can provide pain relief and decrease disability in plantar fasciitis patients when used as part of a comprehensive treatment regimen 4. A randomized controlled study showed that adding celecoxib to a conservative treatment regimen (including heel-cord stretching, heel cups, and night splinting) improved pain scores by a factor of 5.2 over 6 months compared to 3.6 in the placebo group 4.

Important Considerations and Cautions

• Duration: Limit NSAID use to short-term treatment (1-2 weeks) due to potential side effects 2

• Risk factors: Consider cardiovascular, gastrointestinal, and renal risks, particularly in elderly patients 5

• Contraindications: Avoid NSAIDs in patients with:

  • History of asthma attack, hives, or allergic reaction with aspirin or other NSAIDs
  • Recent or upcoming heart bypass surgery
  • Late pregnancy 5

• Monitoring: Watch for side effects including:

  • GI symptoms: stomach pain, nausea, vomiting
  • Cardiovascular effects: chest pain, shortness of breath
  • Skin reactions: rash, blisters with fever 5

Treatment Expectations

With proper treatment including NSAIDs, approximately 80% of patients with plantar fasciitis improve within 12 months 3. However, the condition can be resistant to treatment, and a combination approach is often necessary 6.

Remember that NSAIDs address the pain and inflammation but should be combined with other conservative measures like stretching exercises and appropriate footwear for optimal results.