From the Guidelines
Plantar fasciitis should be initially managed with conservative measures, including rest, ice application, over-the-counter pain relievers, stretching exercises, and supportive footwear, as these measures have been shown to improve symptoms in most cases within 6-12 weeks 1.
Initial Management
The initial management of plantar fasciitis involves a combination of non-pharmacological and pharmacological interventions.
- Rest and ice application for 15-20 minutes several times daily can help reduce inflammation and alleviate pain.
- Over-the-counter pain relievers like ibuprofen (400-800mg three times daily) or naproxen (220-440mg twice daily) can be used for 1-2 weeks to manage pain and inflammation.
- Stretching exercises, such as calf stretches against a wall, plantar fascia stretches by pulling the toes toward the shin, and rolling the foot over a frozen water bottle for 5 minutes several times daily, are crucial in improving symptoms.
Diagnostic Imaging
While radiography is typically insensitive in the diagnosis of fasciitis, it should be the initial imaging study in patients with a painful heel, as evidence supports the use of weightbearing radiographs in this instance 1.
- The combination of thickened plantar fascia and fat pad abnormalities on radiographs has a sensitivity of 85% and a specificity of 95% for plantar fasciitis.
Further Management
For persistent pain, a healthcare provider may recommend physical therapy, custom orthotics, steroid injections, or in rare cases, surgery.
- Plantar fasciitis often results from repetitive stress to the fascia, particularly in runners, overweight individuals, or those who stand for long periods, causing small tears and inflammation in the tissue.
Key Considerations
It is essential to note that local injections of corticosteroids are not recommended as an initial treatment option 1.
- Immobilization may be considered in particularly acute or refractory cases.
- Most cases of plantar fasciitis improve within 6-12 weeks with conservative measures, and further management should be guided by the severity of symptoms and the response to initial treatment.
From the Research
Definition and Prevalence 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 estimated that one in 10 people will experience plantar fasciitis in their lifetime 3.
- Plantar fasciitis is a self-limiting condition, but it can be resistant to treatment and frustrating for patients and practitioners alike 4.
Risk Factors and Causes
- Risk factors for developing plantar fasciitis include obesity, excessive foot pronation, excessive running, and prolonged standing 2.
- Limited ankle dorsiflexion, increased body mass index, and standing for prolonged periods of time are also risk factors 3.
- Plantar fasciitis is considered to be most often the result of a degenerative process at the origin of the plantar fascia at the calcaneus 4.
Diagnosis and Symptoms
- Diagnosis of plantar fasciitis is primarily based on history and physical examination 2.
- Patients may present with heel pain with their first steps in the morning or after prolonged sitting, and sharp pain with palpation of the medial plantar calcaneal region 2.
- Symptoms are stabbing, nonradiating pain first thing in the morning in the proximal medioplantar surface of the foot; the pain becomes worse at the end of the day 3.
Treatment Options
- Conservative treatments, such as rest, activity modification, ice massage, oral analgesics, and stretching techniques, can help with the disabling pain 2.
- Physician-prescribed treatments, such as physical therapy modalities, foot orthotics, night splinting, and corticosteroid injections, can be considered if heel pain persists 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 5.
- Surgical treatment is considered in only a small subset of patients with persistent, severe symptoms refractory to nonsurgical intervention for at least 6 to 12 months 6.
Treatment Outcomes
- Approximately 90% of patients with plantar fasciitis will improve with conservative techniques 2, 4, 6.
- With proper treatment, 80% of patients with plantar fasciitis improve within 12 months 3.
- The combination of corticosteroid injections and training (strength training and stretching) has been shown to be the best treatment for plantar fasciitis, with superior effects in both the short- and long-term 5.