What is the treatment for plantar fasciitis?

Treatment of Plantar Fasciitis

The most effective treatment for plantar fasciitis involves a stepwise approach starting with conservative measures including regular calf-muscle stretching, plantar fascia-specific stretches, appropriate footwear, and over-the-counter orthoses, followed by more advanced interventions only if initial treatments fail. 1

Initial Conservative Treatment (First 6 Weeks)

• Patient-directed measures:

  • Regular calf-muscle and plantar fascia-specific stretching exercises (most important initial intervention) 1, 2
  • Ice massage to the affected area, especially after activity 1, 2
  • Over-the-counter heel cushions and arch supports 1
  • Weight loss if the patient is overweight or obese 1, 2
  • Activity modification to decrease repetitive loading of the plantar fascia 3
  • Avoidance of flat shoes and barefoot walking 1

• Medication:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief 1, 4
    • While NSAIDs may provide some benefit when combined with other conservative measures, evidence suggests their effect may be modest 4

• Basic supportive treatments:

  • Padding and strapping of the foot 1
  • Night splints to maintain dorsiflexion during sleep 1, 2

Secondary Interventions (If No Improvement After 6 Weeks)

If symptoms persist after 6 weeks of initial treatment, consider:

• Customized orthotic devices tailored to the patient's foot structure 1
• Corticosteroid injections (limited number) 1
  • Note: While effective for short-term pain relief, these must be used cautiously due to risks of fat pad atrophy and plantar fascia rupture 3
• Immobilization via casting or fixed-ankle walker-type device during activity 1

Advanced Interventions (If No Improvement After 2-3 Months)

For recalcitrant cases that don't respond to previous treatments:

• Extracorporeal shock wave therapy (ESWT) - particularly ultrasonography-guided focal ESWT 1, 3
• Cast immobilization if not previously attempted 1
• Surgical intervention - plantar fasciotomy may be considered when all conservative measures have failed 1, 5
  • Endoscopic fasciotomy is an option for patients with persistent pain that limits function despite exhausting non-operative treatments 2

Treatment Efficacy and Prognosis

• With proper treatment, approximately 80% of patients with plantar fasciitis improve within 12 months 2
• Conservative treatment is ultimately effective in approximately 90% of patients 6
• Surgical success rates for plantar fascia release are approximately 70-90% in recalcitrant cases 5

Diagnostic Considerations

• Plantar fasciitis is predominantly a clinical diagnosis 2
• Key symptoms include stabbing, non-radiating pain first thing in the morning in the proximal plantar surface of the foot 2
• Physical examination typically reveals tenderness at the proximal plantar fascial insertion at the anteromedial calcaneus 2
• For persistent pain beyond 3 months despite treatment, ultrasonography is a reasonable diagnostic tool 2
  • US has good sensitivity (80%) and specificity (88%) in diagnosing plantar fasciitis compared to MRI 1

Common Pitfalls to Avoid

• Failing to address biomechanical factors like tight Achilles tendon 6
• Overreliance on corticosteroid injections without considering risks 3
• Premature consideration of surgical intervention before exhausting conservative options 1, 2
• Not allowing sufficient time for conservative treatments to work (most cases resolve within 12 months) 2