What treatment do I give for plantar fasciitis?

Treatment of Plantar Fasciitis

Start with an 8-12 week supervised exercise program targeting the foot and ankle, combined with properly fitting footwear, plantar fascia stretching, and ice massage. 1, 2

First-Line Conservative Management

Immediate Interventions (Weeks 0-4)

• Prescribe plantar fascia-specific stretching exercises performed daily, particularly first thing in the morning before weight-bearing 1, 3
• Recommend properly fitting footwear that accommodates foot shape and provides adequate support; instruct patients to avoid walking barefoot or in thin-soled slippers 1
• Advise ice massage to the affected area for pain relief 2, 3
• Consider NSAIDs (such as celecoxib) for pain control, though evidence shows only modest benefit when added to conservative measures, with trends toward improved outcomes between 2-6 months 4
• Modify activities by reducing prolonged standing and high-impact activities 2

Physician-Directed Treatments (Weeks 4-12 if inadequate response)

• Refer to physical therapy for supervised exercise program focusing on plantar fascia and Achilles tendon stretching 1, 2
• Prescribe foot orthotics (soft plantar insoles or custom orthoses) which have limited but supportive evidence 5
• Consider corticosteroid injections for persistent pain, recognizing they provide short-term benefit only 5
• Night splints are commonly used but lack strong evidence over placebo 3

Diagnostic Imaging (Only if Pain Persists Beyond 3 Months)

• Order ultrasonography as a reasonable, inexpensive first-line imaging study showing increased plantar fascia thickness (>4mm typically indicates plantar fasciitis) 1, 3
• Reserve MRI for characterizing the fascia and ruling out other pathology when diagnosis remains uncertain 1, 2

Refractory Cases (After 6+ Months of Conservative Treatment Failure)

• Consider extracorporeal shock wave therapy for chronic recalcitrant cases 2, 3
• Evaluate for surgical intervention (endoscopic plantar fasciotomy) only after exhausting all nonoperative options 3
• Digital flexor tenotomy may be considered in specific cases with hammertoe deformity and pre-ulcerative signs 1

Expected Outcomes

Approximately 90% of patients improve with conservative treatment within 12 months, though 80% show improvement by 12 months with proper management 2, 6, 3. The condition is self-limiting but requires patience and adherence to the treatment regimen 2.

Critical Pitfalls to Avoid

• Do not rely solely on NSAIDs without concurrent stretching and activity modification, as they provide minimal additional benefit alone 4
• Avoid premature surgical referral before completing at least 6 months of comprehensive conservative therapy 3
• Do not order imaging routinely at initial presentation; diagnosis is clinical based on characteristic morning pain and medial calcaneal tenderness 2, 3