Can duloxetine be used to treat plantar fasciitis?

Duloxetine for Plantar Fasciitis

Duloxetine is not recommended as a treatment for plantar fasciitis as there is no evidence supporting its use for this specific condition, despite its established efficacy in other pain conditions such as osteoarthritis and neuropathic pain.

Current Evidence for Plantar Fasciitis Treatment

• Plantar fasciitis is a common condition affecting approximately 10% of people during their lifetime, characterized by stabbing pain in the proximal medioplantar surface of the foot, particularly severe with the first steps in the morning 1
• First-line treatments with established efficacy include:
  • Stretching of the plantar fascia and Achilles tendon 1
  • Ice massage 1
  • NSAIDs 2

Duloxetine's Established Pain Indications

• Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI) with evidence-based efficacy in:

  • Osteoarthritis pain of the knee and hip 3
  • Neuropathic pain, particularly diabetic peripheral neuropathy 4
  • Chronic low back pain 3

• When used for approved pain conditions, duloxetine:

  • Should be initiated at 30 mg/day for one week before increasing to 60 mg/day 3, 4
  • Must be taken daily (not as needed) 3
  • Should be tapered over 2-4 weeks when discontinuing after treatment longer than 3 weeks 3, 4

Why Duloxetine is Not Indicated for Plantar Fasciitis

• None of the current clinical practice guidelines for plantar fasciitis mention duloxetine as a treatment option 1, 5

• The established treatments for plantar fasciitis focus on:

  • Mechanical interventions (stretching, orthotics, night splints) 1
  • Anti-inflammatory approaches (NSAIDs, corticosteroid injections) 2, 6
  • Load reduction strategies 6

• For recalcitrant cases of plantar fasciitis, evidence supports:

  • Corticosteroid injections, which have shown superior efficacy when combined with controlled training (strength training and stretching) 6
  • Extracorporeal shock wave therapy in some cases 1

Clinical Approach to Plantar Fasciitis

• Begin with conservative measures:

  • Plantar fascia and Achilles tendon stretching exercises 1
  • Ice massage to the affected area 1
  • NSAIDs for pain relief 2
  • Viscoelastic heel cups and night splints 2

• For cases not responding to initial treatment:

  • Consider corticosteroid injections, which have demonstrated efficacy particularly when combined with a controlled training program 6
  • Acupuncture may provide additional benefit when combined with traditional approaches 7

• With proper treatment, approximately 80% of patients improve within 12 months 1

Caution

• While duloxetine is effective for certain pain conditions, applying it to plantar fasciitis would be off-label and without supporting evidence 3
• Using medications without evidence of efficacy for specific conditions exposes patients to potential adverse effects without established benefits 4, 8