Treatment of Plantar Fasciitis
Start with plantar fascia-specific stretching exercises and calf stretching as your primary intervention—this is the most important initial treatment for plantar fasciitis. 1
Initial Conservative Management (First 6 Weeks)
The following interventions should be implemented immediately:
Stretching exercises are the cornerstone of treatment: Regular calf-muscle and plantar fascia-specific stretching should be performed daily, as this represents the most critical initial intervention 1
Ice massage should be applied to the affected area, particularly after activity 1
Over-the-counter heel cushions and arch supports provide immediate symptomatic relief 2, 1
Activity modification is essential—patients must limit activities that involve prolonged standing, walking, or running 3
Footwear modifications: Patients should avoid flat shoes and barefoot walking entirely 2, 1
Weight loss should be recommended if the patient is overweight or obese 2, 1
Padding and strapping of the foot provides additional support 2, 1
Night splints to maintain dorsiflexion during sleep can be added, though evidence for their superiority over placebo is limited 1, 4
Secondary Interventions (After 6 Weeks Without Improvement)
If symptoms persist after six weeks of initial treatment, escalate to:
Customized orthotic devices tailored to the patient's specific foot structure 1
Corticosteroid injections may be considered, but use judiciously—effects are short-lived and carry risks of fat pad atrophy and plantar fascia rupture 2, 1, 3
Immobilization via casting or fixed-ankle walker-type device during activity 2, 1
Referral to a podiatric foot and ankle surgeon is appropriate at this stage 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, should be considered as the next step before surgery 1, 3
Cast immobilization if not previously attempted 1
Surgical intervention (plantar fasciotomy or endoscopic fasciotomy) should be reserved only when all conservative measures have been exhausted 2, 1, 4
Diagnostic Considerations
Clinical diagnosis is primary: Look for stabbing, nonradiating pain in the proximal medioplantar surface of the foot that is worst with first steps in the morning and worsens at end of day 4
Physical examination: Tenderness to palpation at the proximal plantar fascial insertion at the anteromedial calcaneus is the key finding 4
Ultrasonography is reasonable and inexpensive for patients with pain persisting beyond three months despite treatment, with 80% sensitivity and 88% specificity 1, 4
Critical Pitfalls to Avoid
Do not delay treatment: Symptoms resolve more quickly when treatment begins earlier 5
Limit corticosteroid injections: Multiple injections increase risk of complications including fat pad atrophy and plantar fascia rupture 3
Do not rush to surgery: Conservative treatment is ultimately effective in approximately 90% of patients, and 80% improve within 12 months with proper treatment 6, 4
Avoid central Achilles tendon injections: When treating insertional Achilles tendonitis (a differential diagnosis), local corticosteroid injections are not recommended 2