From the Guidelines
Treatment for a low-grade partial thickness tear of the plantar fascia should begin with conservative measures, including rest, ice, and over-the-counter pain medications, and continued for at least six weeks before considering referral to a specialist 1. When managing low-grade partial thickness tears of the plantar fascia, it's essential to prioritize conservative treatment approaches to minimize morbidity, mortality, and improve quality of life.
- Initial treatment measures should include:
- Rest and reducing activities that exacerbate pain
- Applying ice to the affected area for 15-20 minutes, 3-4 times daily
- Taking non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen for 1-2 weeks to reduce pain and inflammation
- Wearing supportive shoes with cushioned soles and considering over-the-counter arch supports or custom orthotics
- Gentle stretching exercises for the plantar fascia and Achilles tendon should be performed 2-3 times daily, holding each stretch for 30 seconds and repeating 5 times 1.
- If no improvement occurs after six weeks, referral to a podiatric foot and ankle surgeon is appropriate, and additional treatments may include a customized orthotic device, night splinting, or a limited number of corticosteroid injections 1.
- It's crucial to continue initial treatment measures until symptoms resolve, and if no improvement occurs after two to three months, further options like cast immobilization, surgery (plantar fasciotomy), or extracorporeal shock wave therapy may be considered 1.
From the Research
Treatment Options for Low Grade Partial Thickness Tear Plantar Fasciitis
- The treatment for plantar fasciitis should start with stretching of the plantar fascia, ice massage, and nonsteroidal anti-inflammatory drugs 2
- Combining corticosteroid injection and physical training (strength training and stretching) has been shown to result in a superior effect compared to each treatment separately 3
- Autologous platelet-rich plasma (PRP) injections have been found to be superior to corticosteroid injections in terms of long-term pain alleviation and functional improvement for patients suffering from chronic plantar fasciitis 4
- Initial treatment consists of activity modification, anti-inflammatory medication, gastrocnemius and plantar fascia stretching, and an in-shoe orthosis that lifts and cushions the heel, leading to complete resolution of pain in 90% of patients 5
Comparison of Treatment Options
- A systematic review and meta-analysis found that PRP achieved better VAS scores compared to CSI at 3 and 6-month follow-up, and ESWT had better VAS score outcomes at 6 months compared to CSI 6
- The same study found that PRP was more efficacious than CSI at 6 months of follow-up in terms of AOFAS score 6
- Corticosteroid injections combined with controlled training are recommended as first line treatment in patients with plantar fasciitis 3
Minimally Invasive Treatments
- Platelet-rich plasma injections and therapeutic ultrasound are among a number of minimally invasive treatments that stimulate the body's healing response 5
- Corticosteroid injections temporarily relieve pain, but may increase the risk of plantar fascia rupture and fat pad atrophy 5
- Botulinum toxin injections relax the calf muscles, which decreases the stress in the plantar fascia 5