From the Guidelines
Treatment for symptomatic plantar fasciitis should begin with conservative measures, including rest, ice application, activity modification, and NSAIDs, as well as stretching exercises and proper footwear with good arch support and cushioning. The goal of these initial treatments is to reduce stress on the foot, manage pain and inflammation, and promote healing of the plantar fascia. According to 1, initial treatment options may also include open-backed shoes, orthoses, accommodative padding, and weight loss if indicated. It is essential to avoid flat shoes and barefoot walking, as they can exacerbate the condition.
Some key considerations in the treatment of symptomatic plantar fasciitis include:
- Rest, ice application for 15-20 minutes several times daily, and activity modification to reduce stress on the foot
- Over-the-counter NSAIDs like ibuprofen or naproxen to manage pain and inflammation for short periods
- Stretching exercises, such as calf stretches and plantar fascia-specific stretches, to promote healing and reduce tension
- Proper footwear with good arch support and cushioning to reduce pressure on the area
- Night splints to maintain a stretched position of the plantar fascia during sleep
If symptoms do not improve within six to eight weeks, other diagnoses may need to be considered, and patients should be referred to a podiatric foot and ankle surgeon, as suggested by 1. In such cases, immobilization casts or fixed-ankle walker-type devices may be added to the treatment plan, and bursa injection or surgical procedures like resection of the prominent posterior superior aspect of the calcaneus and inflamed bursa may be considered. However, corticosteroid injections should be used with caution, as their effectiveness and safety are still debated, and local injections of corticosteroids are not recommended by 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Symptomatic Plantar Fasciitis
- Initial treatment should include stretching of the plantar fascia, ice massage, and nonsteroidal anti-inflammatory drugs 2
- Recalcitrant plantar fasciitis can be treated with injections, extracorporeal shock wave therapy, or surgical procedures, although evidence is lacking 2
- Oral nonsteroidal anti-inflammatory medication (NSAID) may increase pain relief and decrease disability in patients with plantar fasciitis when used with a conservative treatment regimen 3
- Extra-corporeal shock wave therapy (ESWT) was found to be more effective than methylprednisolone injections for treatment of plantar fasciitis 4
- Nonsurgical management of plantar fasciitis is successful in approximately 90% of patients, with options including rest, massage, nonsteroidal anti-inflammatory drugs, night splints, heel cups/pads, custom and off-the-shelf orthoses, injections, casts, and physical therapy measures such as shock wave therapy 5
Effectiveness of Different Treatments
- ESWT was found to have significant improvement in pain relief compared to methylprednisolone injections 4
- NSAIDs were found to have a trend towards improved pain relief and disability in patients with plantar fasciitis 3
- Nonsurgical treatment modalities have been shown to be successful in approximately 90% of patients with plantar fasciitis 5
Considerations for Treatment
- Plantar fasciitis is predominantly a clinical diagnosis, with symptoms including stabbing, nonradiating pain first thing in the morning in the proximal medioplantar surface of the foot 2
- Risk factors for plantar fasciitis include limited ankle dorsiflexion, increased body mass index, and standing for prolonged periods of time 2
- Treatment should be tailored to the individual patient, with consideration of their specific symptoms and risk factors 2, 3, 4, 5