From the Guidelines
To treat plantar fasciitis, initial treatment options should include open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated) as recommended by the American College of Foot and Ankle Surgeons 1. The goal of treatment is to reduce pain and inflammation, and to improve mobility and quality of life.
- Initial treatment measures should be continued for six to eight weeks, or until symptoms resolve, as stated in the American Family Physician journal 1.
- If no improvement occurs after six weeks, referral to a podiatric foot and ankle surgeon is appropriate, and additional treatments may be considered, such as customized orthotic devices, night splinting, or limited corticosteroid injections 1.
- It is essential to note that local injections of corticosteroids are not recommended as an initial treatment option, according to the American College of Foot and Ankle Surgeons 1.
- In cases where pain persists beyond 6-8 weeks, further options may include physical therapy, custom orthotics, or in rare cases, surgery, as suggested by the American Family Physician journal 1.
- The treatment plan should prioritize conservative measures, such as rest, ice, and stretching exercises, to minimize the risk of complications and improve patient outcomes, as recommended by the American College of Foot and Ankle Surgeons 1.
From the Research
Treatment Options for Plantar Fasciitis
- Conservative therapies are commonly used to treat plantar fasciitis, including rest, ice massage, stretching of the Achilles tendon and plantar fascia, nonsteroidal anti-inflammatory medications (NSAIDs), corticosteroid injections, foot padding, taping, shoe modifications, arch supports, heel cups, custom foot orthoses, night splints, ultrasound, and casting 2
- Oral NSAIDs may increase pain relief and decrease disability in patients with plantar fasciitis when used with a conservative treatment regimen 2
- Noninvasive interactive neurostimulation (NIN) is a form of electric therapy that has been shown to be effective in treating chronic plantar fasciitis, resulting in greater improvement in foot functional score, lower levels of reported pain, and reduced patient consumption of NSAIDs compared to electric shockwave therapy 3
- Supportive treatments, including plantar fascia-specific stretch, calf stretching, appropriate orthotics, and night dorsiflexion splinting, can alleviate plantar fascia pain 4
- Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis 4
- Treatment should start with stretching of the plantar fascia, ice massage, and nonsteroidal anti-inflammatory drugs, with recalcitrant cases potentially requiring injections, extracorporeal shock wave therapy, or surgical procedures 5
- A combination of causative factors may be present, and the true cause of plantar fasciitis may remain obscure, making treatment challenging 6
Common Treatment Approaches
- Nonsurgical treatment is ultimately effective in approximately 90% of patients 6
- Conservative treatment regimens often include a variety of treatments, such as nonsteroidal anti-inflammatory drugs, rest, pads, cups, splints, orthotics, corticosteroid injections, casts, physical therapy, ice, and heat 6
- There is no consensus on the efficacy of any particular conservative treatment regimen, and the natural history of plantar fasciitis has not been established 6
Additional Considerations
- Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality 4
- Ultrasonography is a reasonable and inexpensive diagnostic tool for patients with pain that persists beyond three months despite treatment 5
- Endoscopic fasciotomy may be required in patients who continue to have pain that limits activity and function despite exhausting nonoperative treatment options 5