What is the treatment for plantar fasciitis?

Treatment for Plantar Fasciitis

The most effective treatment for plantar fasciitis follows a stepwise approach, starting with conservative measures like daily plantar fascia-specific stretching exercises, appropriate footwear with cushioning, orthotic devices, ice massage, and NSAIDs for initial management (0-3 months). 1

Initial Conservative Management (0-3 months)

• Daily plantar fascia-specific stretching exercises: Should be performed multiple times daily, especially before first steps in the morning
• Appropriate footwear: Shoes with adequate arch support and cushioning
• Orthotic devices: Arch supports or heel cups
• Ice massage: Apply for 20 minutes, 2-3 times daily
• NSAIDs: For pain management as needed

These conservative measures are effective for approximately 90% of patients within 12 months 2, 3.

Persistent Cases (3-6 months)

For patients who don't respond to initial conservative treatment after 3 months:

• Corticosteroid injection: Combined with continued stretching and strengthening exercises 1
• Night splints: Though evidence is mixed, may be beneficial for some patients 3

Recalcitrant Cases (>6 months)

For cases that persist beyond 6 months despite conservative management:

• Extracorporeal shock wave therapy (ESWT): Particularly effective for chronic cases unresponsive to conservative treatment 1, 3
• Ultrasound-guided therapies: Including platelet-rich plasma injections 1
• Acupuncture: May provide relief for some patients 1

Surgical Options

• Plantar fasciotomy: Consider only after exhausting all non-operative treatment options (typically after 6-12 months of failed conservative management) 2, 3
• Endoscopic fasciotomy: May be required in patients with persistent activity-limiting pain despite comprehensive non-operative treatment 3

Diagnostic Considerations

• Plantar fasciitis is primarily diagnosed clinically based on:

  • Stabbing, non-radiating pain in the proximal medioplantar surface of the foot
  • Pain worst with first steps in the morning
  • Pain worsening at the end of the day
  • Tenderness to palpation at the anteromedial calcaneus 1

• Imaging is rarely needed for initial diagnosis but may be considered for recalcitrant cases:

  • MRI: Most sensitive imaging study for diagnosis of plantar fasciitis 1
  • Ultrasonography: Reasonable and inexpensive diagnostic tool for patients with pain persisting beyond three months 3

Common Pitfalls and Caveats

• Misdiagnosis: Ensure proper diagnosis as other conditions can mimic plantar fasciitis (stress fractures, nerve entrapment)
• Overtreatment: Avoid jumping to invasive treatments before adequate trial of conservative measures
• Inconsistent treatment: Patient adherence to stretching protocols is crucial for success
• Inappropriate footwear: Continuing to wear unsupportive shoes can prolong recovery
• Overlooking contributing factors: Obesity, excessive foot pronation, and prolonged standing should be addressed 2

Remember that plantar fasciitis is often self-limiting, but proper treatment can significantly reduce recovery time and improve quality of life. The majority of patients (90%) will improve with conservative techniques 2.