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

Initial Conservative Treatment (First 6 Weeks)

The following measures should be implemented simultaneously from day one:

Core Interventions

• Stretching exercises are mandatory: Regular calf-muscle and plantar fascia-specific stretching form the foundation of treatment and should be performed daily 1
• Ice massage: Apply ice to the affected area, particularly after activity 1
• Footwear modifications: Use over-the-counter heel cushions and arch supports; avoid flat shoes and barefoot walking entirely 2, 1
• Weight reduction: If the patient is overweight or obese, weight loss is essential 1
• Activity modification: Limit activities that involve prolonged standing or repetitive loading of the plantar fascia 3

Adjunctive Measures

• NSAIDs: While evidence shows only modest benefit, NSAIDs may provide some pain relief and decreased disability when combined with conservative measures 4
• Padding and strapping: Apply supportive padding and strapping to the foot 2, 1
• Night splints: Use dorsiflexion splints during sleep to maintain stretch 1

Important caveat: Many standard treatments like night splints and orthoses have not shown benefit over placebo in some studies, but guidelines still recommend them as part of comprehensive care 5

Secondary Interventions (After 6 Weeks Without Improvement)

If symptoms persist after 6 weeks of initial treatment, escalate to:

• Customized orthotic devices: Tailored to the patient's specific foot structure 1
• Corticosteroid injections: May provide pain relief, but effects are short-lived and carry risks of fat pad atrophy and plantar fascia rupture—use judiciously 2, 1, 3
• Immobilization: Consider casting or fixed-ankle walker-type device during activity 2, 1
• Referral to podiatric foot and ankle surgeon: Appropriate at this stage for specialized management 2

Advanced Interventions (After 2-3 Months Without Improvement)

For recalcitrant cases that fail conservative management:

• Extracorporeal shock wave therapy (ESWT): Particularly ultrasonography-guided focal ESWT is useful for chronic plantar fasciitis 1, 3
• Cast immobilization: If not previously attempted 1
• Surgical intervention: Plantar fasciotomy or endoscopic fasciotomy may be required when all conservative measures have failed and pain continues to limit activity and function 1, 5

Diagnostic Considerations

• Clinical diagnosis: Plantar fasciitis is predominantly diagnosed clinically based on stabbing, non-radiating pain in the proximal medioplantar surface, worst in the morning and at end of day, with tenderness at the anteromedial calcaneus 5
• Ultrasonography: Reasonable and inexpensive diagnostic tool for patients with pain persisting beyond 3 months despite treatment (sensitivity 80%, specificity 88%) 1, 5
• MRI: May be useful to characterize the plantar fascia and adjacent tissues if diagnosis remains unclear 6

Critical Pitfalls to Avoid

• Do not allow barefoot walking: This consistently aggravates the condition 1
• Limit corticosteroid injections: Multiple injections increase risk of fat pad atrophy and plantar fascia rupture 3
• Recognize this is fasciopathy, not fasciitis: The condition is degenerative rather than inflammatory, which explains why anti-inflammatory treatments have limited efficacy 5
• Set realistic expectations: With proper treatment, 80% of patients improve within 12 months, and approximately 90% respond to conservative treatment overall 5, 7