From the Guidelines
Plantar fasciitis treatment should prioritize a combination of rest, stretching exercises, and supportive footwear, with the goal of reducing morbidity, mortality, and improving quality of life. The treatment approach should be multifaceted, including reducing activities that worsen pain, applying ice to the heel for 15-20 minutes several times daily, and performing calf and plantar fascia stretches 3-4 times daily, holding each stretch for 30 seconds 1. Over-the-counter NSAIDs like ibuprofen or naproxen can help manage pain and inflammation for short periods, as recommended by the American College of Foot and Ankle Surgeons 1.
Initial Treatment Measures
- Reduce activities that worsen pain
- Apply ice to the heel for 15-20 minutes several times daily
- Perform calf and plantar fascia stretches 3-4 times daily, holding each stretch for 30 seconds
- Wear supportive shoes with good arch support and cushioning
- Consider over-the-counter heel cups or custom orthotics
Additional Treatment Options
If no improvement occurs after six weeks, referral to a podiatric foot and ankle surgeon is appropriate, and additional treatments may include a customized orthotic device, night splinting, or a limited number of corticosteroid injections 1. It is essential to continue initial treatment measures until symptoms resolve, and to explore other diagnoses if no improvement occurs after two to three months. Further options may include surgery (plantar fasciotomy) and extracorporeal shock wave therapy, as recommended by the American College of Foot and Ankle Surgeons 1.
From the Research
Treatment Options for Plantar Fasciitis
- Conservative treatments such as plantar insoles and stretching exercises have shown limited evidence of benefit 2
- Corticosteroid injections and iontophoresis with steroids have also demonstrated evidence of benefit, although limited and of transient effect 2
- Platelet-rich plasma (PRP) injections have been shown to be effective in reducing pain and improving functional outcomes in patients with chronic plantar fasciitis 3, 4, 5
- Extracorporeal shockwave therapy (ESWT) has also been shown to be effective in reducing pain, but to a lesser extent than PRP injections 3, 4
Comparison of Treatment Modalities
- PRP injections have been shown to be more effective than ESWT, corticosteroid injections, and placebo in reducing pain and improving functional outcomes 4, 5
- PRP injections have also been shown to be more effective than phonophoresis in improving foot functionality and plantar fascia thickness 4
- However, PRP injections did not demonstrate a consistent advantage across all outcome measures, such as plantar fascia thickness and foot functionality 4
Efficacy of PRP Injections
- PRP injections have been shown to be effective in reducing pain and improving functional outcomes in patients with chronic plantar fasciitis, with significant improvements in visual analog scale (VAS) pain scores and American Orthopaedic Foot and Ankle Society (AOFAS) scores 4, 5
- The efficacy of PRP injections has been demonstrated in multiple studies, with consistent results showing significant improvements in pain and functional outcomes 3, 4, 5