What is the treatment for a plantar fasciitis tear?

Treatment of Plantar Fasciitis Tear

Begin immediately with a structured conservative approach consisting of plantar fascia-specific stretching exercises, ice massage, and activity modification, as this resolves symptoms in 90% of patients within 12 months. 1, 2

Initial Conservative Treatment (First 6 Weeks)

The American Academy of Family Physicians identifies stretching as the single most important intervention: 1

• Plantar fascia-specific stretching exercises performed regularly throughout the day 1
• Calf muscle stretching to address tight Achilles tendon, a common biomechanical contributor 1, 3
• Ice massage to the affected area, particularly after activity 1
• Over-the-counter heel cushions and arch supports for immediate symptomatic relief 1
• Activity modification to decrease cyclical repetitive loading of the plantar fascia—this means reducing prolonged standing, walking, and running 3
• Avoid flat shoes and barefoot walking entirely during the treatment phase 1
• Weight loss if the patient is overweight or obese, as this is a significant risk factor 1

Additional Basic Supportive Measures

• Padding and strapping of the foot for mechanical support 1
• Night splints to maintain dorsiflexion during sleep, though evidence for benefit over placebo is limited 1, 4
• Oral NSAIDs may provide modest additional pain relief and decreased disability when combined with conservative measures, though they are not essential 5

Secondary Interventions (After 6 Weeks Without Improvement)

If symptoms persist despite initial conservative treatment, escalate to: 1

• 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—use judiciously 1, 3
• Immobilization via casting or fixed-ankle walker-type device during activity 1

Important Caveat About Corticosteroid Injections

The risk of plantar fascia rupture from corticosteroid injection is a critical consideration, particularly in a patient with an existing tear. 3 Weigh the short-term pain relief against this significant complication risk carefully.

Advanced Interventions (Recalcitrant Cases After 6 Months)

For the 10-20% of patients who fail conservative treatment: 2, 4

• Ultrasonography-guided focal extracorporeal shock wave therapy (ESWT) is the preferred advanced intervention for chronic recalcitrant cases 1, 3
• Cast immobilization if not previously attempted 1
• Surgical intervention (plantar fasciotomy or endoscopic fasciotomy) only when all conservative measures have been exhausted and pain continues to limit activity and function 1, 4

Diagnostic Imaging Considerations

Imaging is not needed for initial diagnosis but should be considered if: 2, 4

• Symptoms persist beyond 3 months despite appropriate treatment 4
• Need to rule out other heel pathology or confirm the diagnosis 2
• Ultrasonography is the reasonable first-line imaging modality with 80% sensitivity and 88% specificity 6
• MRI is the most sensitive study if ultrasonography is inconclusive 6

Critical Clinical Pitfalls

• Do not rely on night splints or standard orthoses as primary treatment—evidence shows no benefit over placebo 4
• Avoid multiple corticosteroid injections due to cumulative risk of rupture and fat pad atrophy 3
• Do not rush to surgery—plantar fasciitis is self-limiting and 90% of patients improve with conservative treatment 2, 7
• Recognize that this is a degenerative process (fasciopathy), not inflammatory—the term "fasciitis" is a misnomer 4