What is the treatment for plantar fasciitis, Achilles tendinosis, and bursitis?

Treatment of Plantar Fasciitis, Achilles Tendinosis, and Bursitis

The most effective treatment for plantar fasciitis is a combination of corticosteroid injections and controlled training (strength training and stretching), which has shown superior outcomes both in short-term and long-term follow-up. 1

Plantar Fasciitis Treatment

First-Line Treatment

1. Conservative Measures

   • Regular stretching of the calf and plantar fascia muscles 2
   • Plantar fascia-specific stretch and eccentric exercises 2
   • Appropriate footwear modifications (shoes with open backs, adequate length 1-2cm longer than foot) 2
   • NSAIDs for pain management (oral or topical) 2, 3
   • Activity modification to decrease repetitive loading 4
   • Cryotherapy (ice massage through wet towel for 10 minutes) 2

2. Orthotic Devices

   • Custom or over-the-counter insoles to redistribute pressure 2
   • Heel pads or shoe inserts 2
   • Night dorsiflexion splinting 4

Second-Line Treatment (if no improvement after 6 weeks)

1. Corticosteroid Injections

   • Consider local injections if initial treatments fail 2
   • Caution: Risk of fat pad atrophy and plantar fascia rupture 4
   • Most effective when combined with controlled training 1

2. Advanced Therapies

   • Ultrasonography-guided extracorporeal shock wave therapy for chronic cases 2, 4
   • Immobilization with cast or fixed ankle walker for refractory cases 2

Surgical Options (after exhausting non-operative treatments)

• Plantar fasciotomy (endoscopic approach preferred) 2
• Approximately 90% of patients improve with conservative treatment without requiring surgery 2

Achilles Tendinosis Treatment

First-Line Treatment

1. Conservative Measures

   • Active physical therapy interventions (supervised exercise) 5
   • Land-based physical therapy interventions 5
   • NSAIDs for pain management 6
   • Activity modification and relative rest

2. Important Caution

   • Avoid local glucocorticoid injections around the Achilles tendon due to risk of tendon rupture 5

Bursitis Treatment

First-Line Treatment

1. Conservative Measures

   • NSAIDs for pain management 6
   • Rest and activity modification
   • Ice application to reduce inflammation

2. Second-Line Treatment

   • Local glucocorticoid injections (except around Achilles, patellar, and quadriceps tendons) 5
   • Physical therapy with focus on strengthening surrounding muscles

Treatment Evaluation and Follow-up

• Evaluate response to treatment every 4-6 weeks 2
• Monitor proper technique with stretching exercises 2
• Assess footwear compliance and orthotic fit 2
• Consider referral to specialist if no improvement after 6 weeks of conservative treatment 2, 7

Special Considerations

• Diabetic Patients: More frequent foot examinations, evaluation for peripheral arterial disease and neuropathy 2
• Athletes: May require more aggressive early intervention and gradual return to activity
• Obesity: Weight management should be addressed as part of treatment plan 7

Treatment Pitfalls to Avoid

1. Injecting corticosteroids near the Achilles, patellar, or quadriceps tendons due to risk of tendon rupture 5
2. Relying solely on passive interventions without active exercises 5
3. Premature return to high-impact activities before adequate healing
4. Failure to address underlying biomechanical issues with appropriate orthotics
5. Rushing to surgical intervention before exhausting conservative options

With proper treatment, approximately 80% of patients with plantar fasciitis improve within 12 months 7, and the combination of corticosteroid injections with controlled training offers the best outcomes for plantar fasciitis 1.