What is the treatment for plantar fasciitis?

Treatment of Plantar Fasciitis

Start immediately with plantar fascia-specific stretching exercises and calf stretching—this is the single most important intervention for plantar fasciitis. 1

First-Line Conservative Treatment (Weeks 0-6)

The initial approach should combine multiple evidence-based interventions simultaneously:

• Stretching exercises targeting both the plantar fascia and calf muscles form the cornerstone of treatment and should be performed regularly 1, 2
• Ice massage to the affected heel, particularly after activity, helps reduce pain 1
• Over-the-counter heel cushions and arch supports provide immediate symptomatic relief 1
• Weight loss if the patient is overweight or obese, as increased BMI is a significant risk factor 1, 3
• Footwear modifications: avoid flat shoes and barefoot walking entirely 1
• Padding and strapping of the foot for additional support 1
• Night splints to maintain dorsiflexion during sleep 1
• NSAIDs for pain control 3
• Activity modification to decrease repetitive loading of the plantar fascia 2

With proper treatment, 80% of patients improve within 12 months, and conservative treatment is ultimately effective in approximately 90% of patients 3, 4

Secondary Interventions (After 6 Weeks of Failed Conservative Treatment)

If symptoms persist beyond 6 weeks despite adherence to first-line measures, escalate to:

• Customized orthotic devices tailored to the patient's specific foot structure 1
• Corticosteroid injections for pain relief, though effects are short-lived and carry risks of fat pad atrophy and plantar fascia rupture 1, 2
• Immobilization via casting or fixed-ankle walker-type device during activity 1

Important caveat: While corticosteroid injections can provide temporary relief, weigh this benefit carefully against the risk of complications, particularly plantar fascia rupture 2

Advanced Interventions (Recalcitrant Cases After 3+ Months)

For chronic plantar fasciitis unresponsive to all previous treatments:

• Ultrasonography-guided focal extracorporeal shock wave therapy (ESWT) is the preferred advanced non-surgical option 1, 2
• Cast immobilization if not previously attempted 1
• Surgical intervention (plantar fasciotomy, either open or endoscopic) should be reserved only when all conservative measures have failed, with success rates of 70-90% 1, 5

Diagnostic Considerations

• Plantar fasciitis is predominantly a clinical diagnosis based on characteristic stabbing, non-radiating pain in the proximal medioplantar foot that is worst first thing in the morning and worsens at day's end 3
• Physical examination reveals tenderness at the anteromedial calcaneus at the proximal plantar fascial insertion 3
• Ultrasonography is reasonable and inexpensive for patients with pain persisting beyond 3 months despite treatment, with 80% sensitivity and 88% specificity compared to MRI 1, 3

Common Pitfalls to Avoid

• Do not rush to injections or advanced therapies—the vast majority of patients respond to conservative treatment if given adequate time (up to 12 months) 3, 4
• Do not underestimate the importance of stretching exercises; this is the most critical intervention and must be emphasized to patients 1
• Avoid corticosteroid injections as a first-line treatment due to complication risks 2
• Surgery should truly be a last resort after exhausting all non-operative options, as conservative treatment succeeds in approximately 90% of cases 4