What are the treatments for heel pain (plantar fasciitis)?

From the Guidelines

Heel pain (plantar fasciitis) can be effectively treated with conservative management, including NSAIDs, orthoses, and stretching exercises.

Initial Treatment Options

• Open-backed shoes to reduce pressure on the area
• Heel lifts or orthoses to support the foot
• NSAIDs to reduce pain and inflammation
• Decreased activity to avoid exacerbating the condition
• Stretching exercises to improve flexibility and reduce tension
• Weight loss, if indicated, to reduce pressure on the foot 1

Additional Treatment Options

• Immobilization may be considered in acute or refractory cases
• Corticosteroid injections may be used, but with caution to avoid injecting the Achilles tendon 1
• Physical therapy may be beneficial in some cases
• If symptoms persist, referral to a podiatric foot and ankle surgeon may be necessary, and surgical options such as resection of the prominent posterior superior aspect of the calcaneus and inflamed bursa may be considered 1

Important Considerations

• Local injections of corticosteroids are not recommended as an initial treatment option 1
• If symptoms do not improve within six to eight weeks, other diagnoses should be considered, and further treatment options should be explored 1

From the Research

Treatment Options for Heel Pain (Plantar Fasciitis)

• Conservative treatments:
  • Rest, activity modification, ice massage, oral analgesics, and stretching techniques 2
  • Physical therapy modalities, foot orthotics, night splinting, and corticosteroid injections 2
  • Anti-inflammatory agents, plantar stretching, and orthosis 3
• Non-surgical treatments:
  • Extracorporeal shock wave therapy 3, 2
  • Plantar fasciotomy 2
• Surgical treatments:
  • Complete plantar fascia release through a medial longitudinal incision, with resection of prominent heel spurs and degenerated areas in the plantar fascia 4
  • Endoscopic fasciotomy for patients who continue to have pain that limits activity and function despite exhausting nonoperative treatment options 5

Effectiveness of Treatments

• Conservative treatments help with disabling pain, with 90% of patients improving with these techniques 2
• Proper treatment can lead to improvement in 80% of patients with plantar fasciitis within 12 months 5
• Some treatments, such as night splints and orthoses, have not shown benefit over placebo 5

Treatment Priorities

• Anti-inflammatory agents, plantar stretching, and orthosis have the highest priority 3
• Corticosteroid injection, night splints, and extracorporeal shock wave therapy are of next priority 3