From the Guidelines
Treatment for plantar fasciitis should begin with conservative approaches, including rest, ice application, and over-the-counter pain medications, as well as stretching exercises and supportive footwear, before considering more invasive options like corticosteroid injections or surgery. The goal of treatment is to reduce inflammation, improve tissue flexibility, and correct biomechanical issues that contribute to excessive strain on the plantar fascia.
Initial Treatment Options
- Rest and ice application for 15-20 minutes several times daily
- Over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-440mg twice daily) to reduce inflammation and pain
- Stretching exercises targeting the plantar fascia and Achilles tendon, performed several times daily, particularly before getting out of bed and after periods of inactivity
- Supportive footwear with good arch support and cushioning, and custom or over-the-counter orthotic inserts for additional relief
Additional Treatment Options
- Night splints to maintain a gentle stretch overnight
- Physical therapy, including exercises, manual therapy, and modalities like ultrasound
- Corticosteroid injections (typically using betamethasone or methylprednisolone mixed with lidocaine) for temporary relief in persistent cases
- Extracorporeal shock wave therapy for cases resistant to other treatments
- Surgery, rarely needed, but may be an option after 6-12 months of failed conservative treatment, as noted in studies such as 1
Footwear and Orthotics
- Well-fitted walking shoes or athletic shoes that cushion the feet and redistribute pressure, as recommended in 1
- Custom-molded shoes for people with bony deformities, including Charcot foot, who cannot be accommodated with commercial therapeutic footwear
It's essential to prioritize conservative approaches and consider the patient's individual needs and circumstances when developing a treatment plan for plantar fasciitis, as emphasized in studies like 1 and 1.
From the Research
Treatment Options for Plantar Fasciitis
- Conservative treatment options are available for plantar fasciitis, including nonsteroidal anti-inflammatory drugs, rest, pads, cups, splints, orthotics, corticosteroid injections, casts, physical therapy, ice, and heat 2
- Nonsurgical treatment is ultimately effective in approximately 90% of patients, although the natural history of plantar fasciitis has not been established 2
- Orthotics, both prefabricated and custom fitted, can reduce pain and improve function in adults with acute plantar fasciitis, with few risks or side effects 3
- Initial treatment for chronic plantar fasciitis consists of activity modification, anti-inflammatory medication, gastrocnemius and plantar fascia stretching, and an in-shoe orthosis that lifts and cushions the heel 4
- Minimally invasive treatments, such as platelet-rich plasma injections and therapeutic ultrasound, can stimulate the body's healing response, while corticosteroid injections can temporarily relieve pain, but may increase the risk of plantar fascia rupture and fat pad atrophy 4
- Operative treatments, including gastrocnemius recession and medial head of gastrocnemius release, and partial plantar fasciotomy, can decrease the stress on the plantar fascia and stimulate a healing response 4
- A conservative approach to plantar heel pain, emphasizing nonsurgical treatment options, can be effective in treating plantar fasciitis 5
Non-Surgical Treatments
- Nonsteroidal anti-inflammatory drugs can help reduce pain and inflammation 2, 4
- Orthotics can reduce pain and improve function in adults with acute plantar fasciitis 3
- Physical therapy, including stretching and exercise, can help improve function and reduce pain 2, 4
- Activity modification, such as avoiding activities that aggravate the condition, can help reduce stress on the plantar fascia 4