From the Guidelines
Plantar fasciitis should be treated with conservative measures, including rest, ice application, and over-the-counter pain relievers, with referral to a podiatric foot and ankle surgeon if no improvement occurs after six weeks 1. To diagnose plantar fasciitis, it is essential to consider the patient's symptoms, such as pain in the heel and bottom of the foot, typically worst with the first steps in the morning or after periods of rest.
- Key characteristics of plantar fasciitis include:
- Insidious onset of pain
- Pain aggravated by increased activity and pressure from shoes
- Relief of pain when walking barefoot
- Initial treatment measures should focus on relieving pain and inflammation, and may include:
- Rest
- Ice application for 15-20 minutes several times daily
- Over-the-counter pain relievers like ibuprofen or naproxen
- Stretching exercises, such as calf stretches and plantar fascia-specific stretches
- Supportive shoes with good arch support and cushioning
- Over-the-counter orthotic inserts
- Night splints to maintain a gentle stretch while sleeping
- If no improvement occurs after six weeks, referral to a podiatric foot and ankle surgeon is appropriate, and additional treatments may be considered, including customized orthotic devices, corticosteroid injections, casting, or surgery 1.
- It is also important to rule out other diagnoses, such as insertional Achilles tendonitis, which can present with similar symptoms, including chronic posterior heel pain and swelling 1.
From the Research
Diagnosis of Plantar Fasciitis
- Plantar fasciitis is a common cause of heel pain, often associated with obesity, middle age, and biomechanical abnormalities in the foot, such as tight Achilles tendon, pes cavus, and pes planus 2
- The condition is considered to be most often the result of a degenerative process at the origin of the plantar fascia at the calcaneus, but neurogenic and other causes of subcalcaneal pain are frequently cited 2
Treatment of Plantar Fasciitis
- Conservative treatment is normally used to manage plantar fasciitis, with a variety of treatments commonly used, such as nonsteroidal anti-inflammatory drugs, rest, pads, cups, splints, orthotics, corticosteroid injections, casts, physical therapy, ice, and heat 2, 3
- Although there is no consensus on the efficacy of any particular conservative treatment regimen, there is agreement that nonsurgical treatment is ultimately effective in approximately 90% of patients 2
- Oral nonsteroidal anti-inflammatory medication (NSAID) has been shown to improve pain and disability in patients with plantar fasciitis, especially when used with a conservative treatment regimen 3
- Noninvasive interactive neurostimulation (NIN) has been shown to be an effective treatment for chronic plantar fasciitis, with significant improvement in foot functional score, pain, and patient satisfaction compared to electric shockwave therapy 4
- Extracorporeal shock wave therapy (ESWT) has been shown to be effective in the treatment of chronic plantar fasciitis, with improvement in pain and functional ability, and may be a safe alternative to corticosteroid injections 5
- An evidence-based review of treatments for plantar fasciitis suggests that conservative measures, such as plantar soft insoles and specific stretching exercises, should be recommended first, with limited evidence supporting the use of steroid injections or iontophoresis when conservative options fail 6