What is the treatment for plantar fasciitis?

Treatment for Plantar Fasciitis

The most effective initial treatment for plantar fasciitis includes regular calf-muscle stretching and plantar fascia-specific stretching exercises, combined with supportive footwear, ice massage, and activity modification. 1

First-Line Treatment Options

• Begin with plantar fascia-specific stretching exercises and calf stretching to reduce tension on the fascia 1
• Apply ice massage (cryotherapy) to the affected area for 5-10 minutes several times daily to reduce pain and inflammation 1, 2
• Use over-the-counter heel cushions, arch supports, or custom orthotics to provide mechanical relief 1, 3
• Modify activities to decrease repetitive loading of the plantar fascia, avoiding prolonged standing, walking, and barefoot walking 1, 3
• Consider weight loss if the patient has elevated BMI, as this reduces mechanical stress on the plantar fascia 1
• Use nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief, though evidence suggests only modest benefits 1, 4
• Implement night splinting to maintain dorsiflexion during sleep 2

Second-Line Treatment Options

• For patients who fail to respond to initial conservative measures after 4-6 weeks:
• Consider corticosteroid injections for short-term pain relief, but be aware of potential risks including fat pad atrophy and plantar fascia rupture 3
• Implement padding and strapping techniques to provide additional support to the foot 1
• Consider ultrasonography-guided extracorporeal shock wave therapy (ESWT) for chronic cases that haven't responded to other treatments 3, 5

Treatment for Recalcitrant Cases (>3 months without improvement)

• For severe cases with disabling symptoms that significantly impact quality of life and function, TNF inhibitors may be considered 1
• Noninvasive interactive neurostimulation (NIN) has shown superior results compared to electric shockwave therapy in terms of functional improvement, pain reduction, and decreased NSAID use 5
• Surgical intervention (endoscopic fasciotomy) may be required for patients who continue to have activity-limiting pain despite exhausting all non-operative treatment options 2

Important Considerations

• Approximately 80% of patients with plantar fasciitis will improve within 12 months with proper treatment 2
• Plantar fasciitis is primarily a clinical diagnosis characterized by stabbing, non-radiating pain in the proximal medioplantar surface of the foot, worst in the morning and at the end of the day 2
• Ultrasonography is reasonable for patients with persistent pain beyond three months despite treatment 2
• Be aware that many standard treatments such as night splints and orthoses have not consistently shown benefit over placebo in all studies, but remain part of comprehensive management 2

Treatment Algorithm

1. Start with conservative measures (stretching, ice, activity modification, supportive footwear) for 4-6 weeks
2. If no improvement, add NSAIDs and night splinting for an additional 4-6 weeks
3. For persistent symptoms beyond 3 months, consider ESWT or corticosteroid injections
4. For severe recalcitrant cases (>6 months), consider TNF inhibitors or surgical consultation for possible endoscopic fasciotomy 1, 2