From the Guidelines
Plantar fasciitis treatment should prioritize a combination of rest, stretching exercises, and supportive footwear, with the goal of reducing inflammation, promoting tissue healing, and correcting biomechanical issues. According to the American College of Foot and Ankle Surgeons, initial treatment options may include open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated) 1. It is essential to reduce activities that worsen heel pain and apply ice to the affected area for 15-20 minutes, 3-4 times daily. Performing calf and plantar fascia stretches several times daily, especially before getting out of bed in the morning, can also help alleviate symptoms. Over-the-counter NSAIDs like ibuprofen or naproxen can help manage pain and inflammation for short periods.
Some key considerations for treatment include:
- Wearing shoes with good arch support and cushioning
- Using heel cups or custom orthotics
- Utilizing night splints to keep the foot dorsiflexed during sleep and prevent morning pain
- Rolling the foot over a frozen water bottle or tennis ball for 5-10 minutes for immediate relief If pain persists beyond 6-8 weeks despite these measures, it is recommended to consult a healthcare provider for additional treatments like corticosteroid injections, physical therapy, or in rare cases, surgery 1. It is crucial to continue initial treatment measures until symptoms resolve, and if no improvement occurs after two to three months, further options like cast immobilization, surgery, or extracorporeal shock wave therapy may be explored.
From the Research
Treatment Options for Plantar Fasciitis
- Various treatment options are available for plantar fasciitis, including physical therapies, orthotics, nonsteroidal anti-inflammatory drugs, and corticosteroid injections 2, 3.
- A systematic review found that combining several physical therapy techniques, such as stretches and shock waves, can be effective in reducing pain and relieving symptoms of plantar fasciitis 2.
- Platelet-rich plasma (PRP) therapy has also been shown to be effective in managing chronic severe tendinopathies, including plantar fasciitis, especially when other techniques have failed 4, 5, 6.
Effectiveness of Platelet-Rich Plasma Therapy
- A meta-analysis found that PRP therapy demonstrated significantly greater improvements in visual analog scale (VAS) pain scores compared to extracorporeal shock wave therapy, corticosteroid injections, and placebo 5.
- PRP therapy also showed a marked advantage over phonophoresis in enhancing foot functionality and improving American Orthopaedic Foot and Ankle Society (AOFAS) scores 5.
- A systematic review and meta-analysis found that PRP injection is considered safe and has a favorable functional outcome and pain control at intermediate and long-term follow-up compared to corticosteroid injection 6.
Comparison of Treatment Modalities
- A study found that PRP therapy did not demonstrate a consistent advantage across all outcome measures, such as plantar fascia thickness and Foot Function Index, highlighting the complexity of plantar fasciitis treatment 5.
- The same study suggested that a more standardized approach to PRP preparation and outcome measurement is needed to fully understand its effectiveness in treating plantar fasciitis 5.
- Another study found that corticosteroid injections can provide temporary relief, but PRP therapy may offer a more sustainable solution for chronic plantar fasciitis 6.