Is cold laser therapy effective for treating plantar fasciitis?

Cold Laser Therapy for Plantar Fasciitis

There is no strong evidence supporting the effectiveness of cold laser therapy for treating plantar fasciitis, and it is not recommended as a primary treatment option.

Current Evidence-Based Treatment Approach

First-Line Conservative Treatments

• Stretching exercises: Specific plantar fascia and calf stretching exercises show limited but positive evidence of benefit 1
• Plantar soft insoles/orthotics: Provide mechanical support and show limited evidence of benefit 1
• NSAIDs: Effective for short-term pain relief (<14 days) without significantly increasing adverse events compared to placebo 2

Second-Line Treatments

• Corticosteroid injections: Show evidence of benefit, though limited and short-term 1
• Iontophoresis with steroids: Demonstrates limited evidence of benefit for short duration 1

For Recalcitrant Cases

• Extracorporeal shock wave therapy: Useful for chronic plantar fasciitis that hasn't responded to conservative measures 3
• Surgical interventions: Only considered after exhausting non-operative treatment options 4

Why Cold Laser Therapy Is Not Recommended

Cold laser therapy (low-level laser therapy) is notably absent from current treatment guidelines for plantar fasciitis. None of the clinical guidelines reviewed mention it as a recommended treatment option 2, 5.

The most recent comprehensive reviews of plantar fasciitis treatments focus on established interventions like stretching, orthotics, NSAIDs, and corticosteroid injections 1, 4, 3, with no mention of cold laser therapy as an evidence-based option.

Treatment Algorithm for Plantar Fasciitis

1. Initial Treatment (0-3 months):

   • Plantar fascia-specific stretching exercises (3-5 times daily)
   • Ice massage to the plantar fascia (10-15 minutes, 2-3 times daily)
   • NSAIDs for pain management
   • Appropriate footwear with arch support

2. If no improvement after 6-8 weeks:

   • Consider corticosteroid injection
   • Night splints to maintain dorsiflexion
   • Activity modification to decrease repetitive loading

3. For persistent cases (>3 months):

   • Ultrasound-guided evaluation to confirm diagnosis
   • Consider extracorporeal shock wave therapy
   • Evaluate for other causes of heel pain

4. For cases resistant to all conservative measures (>6 months):

   • Consider surgical consultation for possible plantar fascia release

Common Pitfalls to Avoid

1. Overreliance on unproven therapies: Many treatments for plantar fasciitis lack strong evidence, including cold laser therapy. Focus on treatments with at least limited evidence of benefit.

2. Inadequate duration of conservative treatment: Approximately 80% of patients improve within 12 months with proper conservative treatment 4. Patience and consistency with first-line treatments are essential.

3. Ignoring biomechanical factors: Limited ankle dorsiflexion, increased BMI, and prolonged standing are risk factors that should be addressed as part of treatment 4.

4. Multiple corticosteroid injections: While effective for short-term relief, repeated injections increase risk of fat pad atrophy and plantar fascia rupture 3.

In conclusion, while numerous treatment options exist for plantar fasciitis, cold laser therapy lacks sufficient evidence to be recommended. Clinicians should focus on evidence-based approaches starting with conservative measures like stretching, orthotics, and NSAIDs before progressing to more invasive options.