Is DMSO (dimethyl sulfoxide) effective for treating plantar fasciitis?

DMSO is Not Recommended for Treating Plantar Fasciitis

DMSO (dimethyl sulfoxide) is not recommended for the treatment of plantar fasciitis as there is no evidence supporting its effectiveness for this condition, and treatment should instead focus on established first-line interventions such as stretching exercises, appropriate footwear, and orthotic devices.

Understanding Plantar Fasciitis

Plantar fasciitis is a common foot condition characterized by:

• Stabbing, non-radiating pain in the proximal medioplantar surface of the foot
• Pain that is typically worst with first steps in the morning
• Pain that may worsen at the end of the day
• Tenderness to palpation at the anteromedial calcaneus (heel bone)

Evidence-Based Treatment Approach

First-Line Treatments (Strong Evidence)

1. Conservative measures should be the initial approach for all patients with plantar fasciitis 1:

   • Specific stretching exercises targeting the plantar fascia
   • Appropriate footwear modifications
   • Orthotic devices (plantar soft insoles)
   • Ice massage to the affected area

2. NSAIDs may provide some benefit when used alongside conservative treatments 2, 3:

   • While not universally effective, NSAIDs can help reduce pain and disability
   • Should be used with consideration of cardiovascular, gastrointestinal, and renal risks

Second-Line Treatments (For Persistent Cases)

For cases that fail to respond to first-line treatments after 3-6 months:

1. Corticosteroid injections have shown evidence of benefit, particularly when combined with controlled training 4:

   • The combination of corticosteroid injections and training (strength training and stretching) has demonstrated superior outcomes compared to either treatment alone
   • This approach showed clinically relevant improvements in both foot function and pain scores

2. Other interventions to consider for recalcitrant cases:

   • Extracorporeal shock wave therapy (ESWT) for chronic cases (>6 months) 1, 5
   • Night splints, although evidence is limited 3
   • Acupuncture has shown promising short-term results at one month 5

Why DMSO is Not Recommended

While DMSO has been studied for other medical applications:

1. There is no evidence in the guidelines or research literature supporting DMSO use specifically for plantar fasciitis
2. DMSO has only been mentioned in the context of chemotherapy extravasation management 6, not musculoskeletal conditions
3. Current guidelines for plantar fasciitis do not include DMSO as a recommended treatment option 1

Treatment Algorithm for Plantar Fasciitis

1. Initial Treatment (0-3 months):

   • Daily plantar fascia-specific stretching exercises
   • Appropriate footwear with cushioning
   • Orthotic devices (arch supports, heel cups)
   • Ice massage (20 minutes, 2-3 times daily)
   • NSAIDs for pain management

2. Persistent Cases (3-6 months):

   • Corticosteroid injection combined with continued stretching and strengthening exercises
   • Consider night splints

3. Recalcitrant Cases (>6 months):

   • Extracorporeal shock wave therapy
   • Consider acupuncture
   • Ultrasound-guided therapies or platelet-rich plasma injections
   • Surgical consultation for endoscopic fasciotomy if all other treatments fail

Important Considerations

• Approximately 80% of patients improve within 12 months with proper treatment 3
• Avoid experimental or unproven treatments like DMSO that lack evidence for plantar fasciitis
• For severe cases involving enthesitis in patients with underlying conditions like psoriatic arthritis, TNF inhibitors might be considered, but this is specific to inflammatory arthropathies, not typical plantar fasciitis 6

Remember that consistent application of evidence-based conservative treatments remains the cornerstone of plantar fasciitis management, with more invasive options reserved only for cases that fail to respond to these measures.