What are the recommended treatments for plantar fasciitis?

Treatment of Plantar Fasciitis

Start with regular calf-muscle and plantar fascia-specific stretching exercises as the cornerstone of initial treatment, combined with ice massage, over-the-counter heel cushions/arch supports, activity modification, and avoidance of flat shoes or barefoot walking. 1

Initial Conservative Treatment (First 6 Weeks)

The following patient-directed measures should be implemented immediately:

• Stretching exercises are the most important initial intervention—specifically regular calf-muscle stretching and plantar fascia-specific stretches 1
• Ice massage (cryotherapy) applied to the affected area, especially after activity 2, 1
• Over-the-counter heel cushions and arch supports for immediate mechanical relief 2, 1
• Weight loss if the patient is overweight or obese 2, 1
• Activity limitation to reduce cyclical repetitive loading of the plantar fascia 3
• Avoid flat shoes and barefoot walking at all times 2, 1
• NSAIDs for pain control 2
• Padding and strapping of the foot for additional support 2, 1

Conservative treatment is ultimately effective in approximately 90% of patients, though the timeline varies 4, 5

Secondary Interventions (After 6 Weeks Without Improvement)

If symptoms persist after 6 weeks of initial conservative treatment, escalate to:

• Customized orthotic devices tailored to the patient's specific foot structure (not just off-the-shelf inserts) 2, 1
• Night splints to maintain dorsiflexion during sleep 2, 1
• Corticosteroid injections (limited number)—these provide short-term pain relief but effects are temporary and must be weighed against risks of fat pad atrophy and plantar fascia rupture 2, 1, 3
• Casting or fixed-ankle walker-type device during activity for immobilization 2, 1
• Physical therapy modalities 5

Continue initial conservative measures alongside these interventions 2

Advanced Interventions (After 2-3 Months or 6+ Months of Recalcitrant Disease)

For chronic cases that fail to respond to the above treatments:

• Extracorporeal shock wave therapy (ESWT)—particularly ultrasonography-guided focal ESWT—is useful for recalcitrant cases 1, 3, 5
• Cast immobilization if not previously attempted 2, 1
• Surgical intervention (plantar fasciotomy) when all conservative measures have failed after 6+ months 2, 1, 5

Critical Pitfalls to Avoid

• Do not rely solely on corticosteroid injections as they provide only short-lived relief and carry risks of fat pad atrophy and plantar fascia rupture 3
• Do not skip stretching exercises—they are the most evidence-based intervention and should be emphasized from day one 1
• Do not allow patients to continue barefoot walking or wearing flat shoes, as these are the most frequent causes of persistent symptoms even during treatment 2
• Do not rush to advanced interventions—90% of patients improve with conservative treatment alone 4, 5

Diagnostic Considerations

• Diagnosis is primarily clinical based on history (heel pain with first steps in morning or after prolonged sitting) and physical examination (sharp pain with palpation of medial plantar calcaneal region) 5
• Ultrasonography has good sensitivity (80%) and specificity (88%) if imaging is needed for recalcitrant cases 1
• Imaging is reserved for cases that don't respond to treatment or to rule out other pathology 5