Treatment of Plantar Fasciitis
Start with plantar fascia-specific stretching exercises and calf stretching as first-line therapy, combined with ice massage and activity modification. 1
First-Line Conservative Management (Initial 6 Weeks)
The American Academy of Family Physicians recommends beginning with these patient-directed interventions 1:
- Plantar fascia-specific stretching exercises performed regularly to reduce pain and improve function 1, 2
- Calf stretching exercises as part of the daily routine 1, 3
- Ice massage applied to the painful area for 5-10 minutes several times daily to reduce inflammation 1
- Avoid flat shoes and barefoot walking to reduce strain on the plantar fascia 1
- Activity modification to decrease repetitive loading of the plantar fascia during the treatment phase 3
- Oral analgesics for pain control during the initial treatment period 2
Second-Line Treatments (If No Improvement After 6 Weeks)
If heel pain persists despite first-line measures, escalate to physician-prescribed treatments 1:
- Customized orthotic devices provide better arch support and cushioning compared to standard insoles 1, 4
- Night splinting to maintain dorsiflexion of the foot while sleeping helps prevent morning pain 1, 2
- Padding and strapping of the foot to provide better support 1
- Corticosteroid injections can provide short-term pain relief, but be aware of significant risks including fat pad atrophy and plantar fascia rupture 1, 3
- Fixed-ankle walker-type devices during activity can reduce strain on the plantar fascia 1
Important Caveat on Corticosteroid Injections
While corticosteroid injections demonstrate limited evidence of benefit, their effects are short-lived and must be carefully weighed against the risk of complications 3, 4. Use these judiciously and only after other conservative measures have failed.
Third-Line Treatments (For Chronic Recalcitrant Cases ≥6 Months)
Reserve these interventions for patients who have exhausted conservative options 1, 2:
- Cast immobilization may be considered for more severe cases 1
- Extracorporeal shock wave therapy (ESWT) is useful for chronic plantar fasciitis unresponsive to other treatments 1, 2, 3
- Surgical intervention (plantar fasciotomy or endoscopic fasciotomy) should be considered only after exhausting all conservative options 1, 5
Diagnostic Imaging Considerations
- Ultrasonography is reasonable and inexpensive for patients whose pain persists beyond three months despite treatment 5
- MRI can characterize the plantar fascia and adjacent tissues when diagnosis remains unclear 6
- Diagnostic imaging is rarely needed for initial diagnosis, which is primarily clinical 2
Expected Outcomes
Approximately 90% of patients improve with conservative treatments within 12 months 2, 5, 7. The natural history favors resolution with time and appropriate conservative management.