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The treatment of plantar fasciitis depends on the particular characteristics of the presenting case, including the duration and severity of symptoms and the likely causes of the symptoms.
In most cases, plantar fasciitis is a self-limiting condition that improves without the need for surgical intervention. The healing process can, however, be improved with adequate rest and other management techniques to promote a smooth recovery.
During the patient consultation when a diagnosis of plantar fasciitis is made, it is important that a thorough history of symptoms, including other medical conditions and relevant lifestyle factors, is taken. This can help to highlight any potential causes and identify patients at risk of complications, which can dictate the treatment plan.
If there are any clear identifiable causes of the pain and inflammation in the heel of the foot, these should be avoided during the recovery period. Likely causes may include long periods standing up, high-impact exercise, unsupportive footwear and overstretching of the sole.
Initially, the RICE protocol is often recommended to reduce swelling and inflammation, which involves:
Physical exercises can then be introduced to improve the strength, stability and flexibility of the plantar fascia, advance recovery, and prevent the recurrence of symptoms.
There are several different types of exercises that may be recommended by the physiotherapist in the treatment of plantar fasciitis. They can usually be carried out using objects found in most homes, such as a towel, wall, stairs or a chair and are typically required to be completed several times a day for a period of at least six weeks for the best results.
Additionally, various other interventions can help to provide support to the foot and improve recovery or prevent recurrence. Splinting, modifications to footwear and the use of orthoses may all be beneficial in some cases. Orthoses fit into the shoe to provide support to the heel and sole.
Simple analgesic medications, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) can offer relief of pain associated with plantar fasciitis. In particular, NSAIDS such as ibuprofen or diclofenac can help to reduce inflammation and assist in improving the recovery time.
For more severe pain, other medications can sometimes be used to manage the symptoms. This may include corticosteroid or Botulinum toxin type A injections directly into the foot to provide localized pain relief.
Some patients will require surgical intervention if the painful symptoms associated with plantar fasciitis do not resolve with physical and pharmacological therapy. This usually requires a referral to an orthopedic or podiatric surgeon who will make decisions regarding the optimal treatment for the specific case.
Plantar release surgery is the most common type of procedure that involves the release of the fascia from the heel bone to reduce the tension. This can be performed via open surgery or endoscopic incision surgery.
Extracorporeal shockwave therapy (EST) is an emerging treatment that is less invasive than surgery as it relies on sound waves to improve symptoms and promote healing. It is thought to reduce the sensitivity of the nerves that carry the pain signal to the brain and stimulate healing in the area, although the full effects are still being researched and evaluated.