How is plantar fasciitis treated?

To treat plantar fasciitis, the doctor may recommend anti-inflammatory medicine, heel and foot and Achilles stretching exercises, and night splints to wear while sleeping to stretch the foot. In some cases, the doctor may suggest a boot, custom-made shoe inserts, steroid shots or injections into the heel. Minimally invasive surgery using an endoscopic partial release technique is another potential solution for people with significant pain following more than six months of conservative treatment. Surgery is used as a last resort and when the diagnosis is confirmed.
Michael Jurgelewicz
Chiropractic Medicine

It is imperative that you have a great history and exam performed so you can be certain you identify the specific nature of your heel pain. There are many signs and symptoms of plantar fasciitis that are also characteristic of several myofascial pain syndromes such as pain referrals from the soleus, gastrocnemius, and flexor digitorum longus muscles that refer to the heel and the plantar surface of the foot. In addition, you want to rule out non-mechanical causes of your heel pain first. Mechanical treatment for a systemic disease causing plantar heel pain will ultimately fail.

Common treatments that have be effective with my patients has been myofascial release (trigger point therapy), moblization of hypomobile joints of the foot, taping, night dorsiflexion splints, cold laser, foot orthotics, and stretching exercises for the achilles tendon and plantar fascia.

Johns Hopkins Medicine
Administration
The vast majority of people with plantar fasciitis - 90 percent - respond to conservative measures such as proper arch support. Rest, ice packs, nonsteroidal anti-inflammatory medications and stretching exercises can help, too.
Tyler S. Carroll, MD
Family Medicine

Plantar fasciitis is usually treated with heel pad/gel inserts into shoes, ice applied to the area (never apply ice directly to skin), heel cord stretches including calf and Achilles tendon, and avoidance of aggravating activities. Stopping aggravating activities; such as jogging, hiking or other weight bearing exercise; often is essential. Unfortunately, plantar fasciitis can be a long term, recurrent problem and therapies such as heel cord stretches and padding to the heel/arch are long term recommendations. If therapy is failing after several months, night splints to stretch the Achilles tendon and foot during sleep are often helpful but are cumbersome. Steroid injections to the area are helpful in some patient but usually reserved for cases not responsive to more conservative measures. Surgery is occasionally attempted but is usually last resort option.

Celeste Robb-Nicholson
Internal Medicine
The best therapy for plantar fasciitis is rest and cushioning the heel, by either wearing a good walking or running shoe or using orthotics. Taking non-steroidal anti-inflammatory drugs (NSAIDs) will reduce inflammation. After the pain has begun to subside, you should stretch the foot gently through low-impact exercise such as swimming and bicycling.

If your pain is severe and unremitting, your doctor may suggest steroid injections. Orthotripsy, an outpatient procedure in which shock waves are directed at the affected heel, may also be effective. Surgery to release the fascia is a last resort.
Christopher Chiodo, MD
Orthopedic Surgery
Plantar fasciitis usually goes away on its own, but it may take awhile -- anywhere from six weeks to a cumbersome 12 months. So treatments are typically aimed at speeding up relief, rather than correcting an anatomical problem. Although a wide range of treatment methods are available, a recent review of significant studies on these therapies found no evidence to support one approach over the other. The report, published in Foot and Ankle International, recommends that physicians limit initial treatment for plantar fasciitis to nonoperative methods.
Dr. Vonda Wright, MD
Orthopedic Surgery
Plantar fasciitis is a painful condition signified by inflammation of the tissue on the sole of the foot. With proper care, this pain can be reduced or even eliminated. In this video, Dr. Oz guest Dr. Vonda Wright explains what to do (and what not to do) to get rid of your plantar fasciitis.
Plantar fasciitis can be treated with a stretching-type program, especially stretching of the calf and Achilles. Thumb and ice-cup massage to the area can also be helpful. If it does not resolve on its own, you may need formal physical therapy.
Rick Olderman
Physical Therapy

Like any area of the body, you must first understand why your plantar fascia is irritated. There are several possible causes of stress to this tissue: 1. the overall mobility of the foot into pronation or supination, 2. footstrike patterns, 3. the structural nature of the femurs (retroversion or anteversion), and 4. calf and soleus muscle length.

Treatment may involve addressing all of these issues through stretching, strengthening, gait training, or even foot orthoses.

Jill A. Grimes, MD
Family Medicine

Whatever you do, do not ignore plantar fasciitis. The worst thing you can do for plantar fasciitis is to grin and bear it, and simply work through the pain. That approach can extend the natural course of this problem from weeks to many months.


The goal of treating plantar fasciitis is to decrease the inflammation in the long ligament on the bottom of your foot.


Plantar fasciitis often is caused or exacerbated by a sudden increase in activity or by new shoes. If you think ill-fitting shoes may be the problem, put aside your high heels and pointy toes and temporarily switch to shoes with a strong, less flexible support. Try buying heel doughnuts or heel cups (which are nonprescription), and if you are upright out of bed, wear shoes with these inserts at all times. This is not a time for bare feet or flip-flops.
Icing the heel after activity and anti-inflammatory medications may help as well, though these steps alone may not be enough to cause great improvement.


Here are a couple exercises that might help:

  • In bare feet, sitting down, using your big toe (one leg at a time) write out the alphabet, first in lower case, and then in upper. Repeat with the other foot, even if it is pain-free (for prevention).

 

  • Set a towel in front of a chair, and use your toes to steadily scrunch the towel, pulling it toward you. Again, repeat with other foot.

  • It may take a few weeks to see results, and consistency is the key. See your family doctor if you are not improving.
Brian Yee
Physical Medicine & Rehabilitation

Pain in the arch or heel of your foot is commonly diagnosed as 'plantar fascitis'. However, there are several reasons that can cause pain at the bottom of the foot. Accurate diagnosis of the source of symptoms is needed to direct the proper course of action. This includes:

Plantar Fascitis: Usually due to an over-stretched arch from a flat or high arch. Treatment by taping, manual therapy, orthotics, and use of night splints can provide relief. Long term prognosis is based not only treating the plantar fascitis itself, but also restoring proper mechanics of the entire leg. 

Nerve Pain: The tibial nerve, which is a branch of the sciatic nerve, can cause symptoms in the bottom of the foot. The key to treatment in nerve injuries is to determine why and where the injury occurred and treat the nerve accordingly. Physical Therapists have specific nerve mobilization techniques to improve nerve integrity.

Myofascial Trigger Points: According to Travell and Simmons, muscle trigger points in the calf and foot muscles can cause referred pain to the foot. Soft tissue techniques and intramuscular manual therapy can be used to treat the trigger points referring and causing the 'plantar fascitis' like symptoms.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.