Initial Treatment for Plantar Fasciitis
Start with plantar fascia-specific stretching exercises, ice massage, and NSAIDs as your first-line treatment approach. 1
First-Line Conservative Management
The initial treatment should focus on these evidence-based interventions:
- Plantar fascia-specific stretching is the cornerstone of treatment and should be performed consistently 1, 2
- Calf stretching exercises help address biomechanical contributors to the condition 2
- Ice massage provides symptomatic relief and reduces inflammation 1
- NSAIDs can be used for pain control during the acute phase 1, 3
- Taping can provide temporary relief by supporting the plantar fascia and may be helpful for immediate symptom management 4
Additional Supportive Measures
- Activity modification to decrease repetitive loading of the plantar fascia should be advised regardless of other treatments chosen 2
- Appropriate orthotics can help alleviate plantar fascia pain, though evidence for standard orthoses over placebo is limited 1, 2
- Night dorsiflexion splinting may provide benefit, though standard night splints have not consistently shown superiority over placebo 1, 2
Important Clinical Context
- 80% of patients improve within 12 months with proper conservative treatment, and approximately 90% ultimately respond to nonsurgical management 1, 5
- Avoid rushing to more invasive treatments in the first 3 months, as the natural course favors resolution with conservative care 1, 5
- Corticosteroid injections should be reserved for recalcitrant cases, as effects are short-lived and carry risks of fat pad atrophy and plantar fascia rupture 2
Common Pitfalls to Avoid
- Do not rely solely on night splints or standard orthoses as monotherapy, since evidence for these interventions over placebo is lacking 1
- Avoid early surgical referral unless the patient has exhausted conservative options and continues to have activity-limiting pain 1
- Consider imaging only if symptoms persist beyond 3 months despite appropriate treatment; ultrasonography is reasonable and cost-effective for persistent cases 1