What is the treatment for plantar fasciitis?

Treatment of Plantar Fasciitis

Start with plantar fascia-specific stretching exercises for 8-12 weeks combined with appropriate footwear, ice massage, and NSAIDs as first-line therapy. 1, 2

Initial Conservative Management (First 3 Months)

Core Treatment Components

• Implement plantar fascia-specific stretching exercises supervised by a qualified healthcare professional for 8-12 weeks, as this has demonstrated benefit 1
• Prescribe calf stretching exercises in addition to plantar fascia stretches 2, 3
• Recommend proper footwear that fits the foot shape appropriately—avoid walking barefoot or in thin-soled slippers both indoors and outdoors 1
• Apply ice massage to the affected area 2, 3
• Consider NSAIDs for pain relief and potential disability reduction, though evidence shows only modest benefit with a trend toward improvement between 2-6 months 2, 4

Activity Modification

• Reduce cyclical repetitive loading of the plantar fascia during the treatment phase regardless of chosen modality 3
• Address risk factors including prolonged standing, obesity, and limited ankle dorsiflexion 2

Adjunctive Measures with Limited Evidence

Orthotic Interventions

• Plantar soft insoles have demonstrated limited evidence of benefit and are reasonable to try given low cost and ease of use 5
• Note that many standard treatments including night splints and orthoses have not shown benefit over placebo in higher-quality studies 2

Diagnostic Imaging (If Pain Persists Beyond 3 Months)

• Obtain ultrasonography as a reasonable and inexpensive diagnostic tool for persistent pain despite conservative treatment 2
• Ultrasound shows 80% sensitivity and 88% specificity compared to MRI 6
• Consider MRI if more detailed characterization of the plantar fascia and adjacent structures is needed, as it is the most sensitive imaging study 6

Second-Line Interventions for Recalcitrant Cases

Injection Therapy

• Corticosteroid injections (local or via iontophoresis) provide short-term pain relief with limited evidence of benefit 2, 5
• Weigh risks carefully: fat pad atrophy and plantar fascia rupture are potential complications 3
• Effects are transient and should only be considered when conservative options fail 5

Advanced Therapies

• Ultrasonography-guided focal extracorporeal shock wave therapy is useful for chronic plantar fasciitis in recalcitrant cases 3
• Endoscopic fasciotomy may be required in patients with continued activity-limiting pain despite exhausting all nonoperative options 2

Expected Outcomes and Timeline

• 80% of patients improve within 12 months with proper conservative treatment 2
• Approximately 90% of patients respond to nonsurgical treatment ultimately, though the condition is frequently resistant to initial interventions 7
• Pain typically manifests as stabbing, nonradiating discomfort in the morning at the proximal medioplantar foot surface, worsening at day's end 2

Critical Pitfalls to Avoid

• Do not rely solely on night splints or standard orthoses as primary treatment—evidence does not support their superiority over placebo 2
• Avoid premature surgical intervention—exhaust conservative options first given the high success rate of nonsurgical management 2, 7
• Do not overlook proper footwear counseling—inappropriate footwear undermines other interventions 1