From the Guidelines
Plantar fasciitis should be initially treated with conservative measures, including rest, ice application, and over-the-counter pain relievers, with referral to a podiatric foot and ankle surgeon if no improvement occurs after six weeks 1. To manage plantar fasciitis, it is essential to start with conservative treatments, such as:
- Rest and avoiding activities that aggravate the condition
- Ice application for 15-20 minutes several times daily
- Over-the-counter pain relievers like ibuprofen or naproxen
- Wearing supportive shoes with good arch support and cushioning
- Using over-the-counter heel cups or custom orthotics
- Performing daily stretching exercises, particularly for the calf muscles and plantar fascia
- Using a night splint to maintain a gentle stretch overnight If symptoms persist, further treatment options may include physical therapy, corticosteroid injections, or extracorporeal shock wave therapy, as recommended by the American College of Foot and Ankle Surgeons 1. Key considerations in treating plantar fasciitis include:
- Identifying and addressing underlying causes, such as excessive pronation, tight calf muscles, or improper footwear
- Implementing weight loss strategies if the patient is overweight, as excess weight can increase pressure on the plantar fascia
- Continuously monitoring symptoms and adjusting treatment plans as needed to ensure optimal outcomes. In cases where conservative measures fail to provide improvement after two to three months, additional options like cast immobilization, surgery (plantar fasciotomy), or extracorporeal shock wave therapy may be considered, as outlined in the American Family Physician journal 1.
From the Research
Definition and Causes of Plantar Fasciitis
- Plantar fasciitis is a common cause of heel pain in adults, affecting more than 1 million persons per year 2.
- It is a self-limiting condition that can affect both sedentary and athletic populations 2.
- Risk factors for developing plantar fasciitis include obesity, excessive foot pronation, excessive running, and prolonged standing 2, 3.
Diagnosis of Plantar Fasciitis
- Diagnosis is primarily based on history and physical examination, with patients presenting with heel pain with their first steps in the morning or after prolonged sitting 2.
- Sharp pain with palpation of the medial plantar calcaneal region and discomfort in the proximal plantar fascia can be elicited by passive ankle/first toe dorsiflexion 2.
- Diagnostic imaging is rarely needed for the initial diagnosis of plantar fasciitis, but may be used to rule out other heel pathology 2, 4.
Treatment Options for Plantar Fasciitis
- Conservative treatments, such as rest, activity modification, ice massage, oral analgesics, and stretching techniques, can help with disabling pain 2.
- Physician-prescribed treatments, including physical therapy modalities, foot orthotics, night splinting, and corticosteroid injections, can be considered if heel pain persists 2.
- Platelet-rich plasma (PRP) injections have been shown to be an effective treatment option for chronic plantar fasciitis, with some studies suggesting it is as effective as or more effective than corticosteroid injections 5, 6.
- Ninety percent of patients will improve with conservative techniques, and patients with chronic recalcitrant plantar fasciitis can consider extracorporeal shock wave therapy or plantar fasciotomy 2.