Plantar Fasciitis Treatment
Plantar fasciitis is the most common cause of heel pain. Fortunately, 80 to 90 percent of all cases can be successfully treated with relatively conservative, nonsurgical therapies. (1, 6)
Once treatment begins, plantar fasciitis usually takes several months to improve. It can take between 6 and 18 months for the condition to subside. (2)
If the patient does not respond to treatment and plantar heel pain persists, surgical treatment may be necessary. Plantar fasciitis surgery has been shown to be very effective, but postoperative complications are still possible. (3)
The most common symptom of plantar fasciitis is heel pain, particularly when patients take their first steps in the morning or after resting for a long period of time. The pain usually subsides over time, but it can increase after activity.
Treatment usually begins with medication to manage the pain and underlying inflammation associated with the condition. Common over-the-counter (OTC) medicines, such as ibuprofen (Advil) and naproxen (Aleve), can help reduce plantar fasciitis pain and swelling.
But these nonsteroidal pain relievers can have side effects, particularly when they are taken over a long period of time. Digestive system complaints, such as heartburn and nausea, are most common. Less common but serious side effects include allergic reactions, hypertension, and liver or kidney damage. (4)
For severe pain and inflammation that do not respond to nonsteroidal medication, your doctor may prescribe cortisone injections. Cortisone drugs or corticosteroids are used to treat a range of conditions, including arthritis, bursitis, and gout, as well as allergic reactions.
These drugs can treat inflammation throughout the body or in specific areas, as is the case with plantar fasciitis. Cortisone can be injected into the plantar fascia, the band of tissue that becomes inflamed in plantar fasciitis.
Cortisone is a powerful anti-inflammatory drug, and it can have severe side effects. Multiple injections can lead to a rupture of the plantar fascia or shrink the fat pad covering the heel bone. (5)
Many of the conservative treatment options for plantar fasciitis are things you can do at home. They involve a combination of resting the foot, avoiding activities that can aggravate the condition, therapies to manage the pain, and techniques to strengthen foot muscles during recovery.
In one study, roughly one-quarter of patients with plantar fasciitis cite rest as the treatment that works best. Avoiding weight-bearing activities and pressure applied to the foot helps relieve pain during the healing process.
Still, rest can be especially difficult for athletes and people whose jobs require a lot of walking and standing. Active individuals can achieve “relative rest” by choosing activities that minimize impact and pressure on the plantar fascia, such as swimming and upper body weight machines. (7)
Like certain medicines, ice can be an effective anti-inflammatory. Typically, cold is applied to the area that hurts or is inflamed for intervals of 15 to 20 minutes.
Cold therapy can be achieved by applying an ice pack to the painful heel or by soaking the heel in an ice bath for 10 to 15 minutes. Icing can be especially helpful after exercise or at the end of a workday.
Exercise can help relieve plantar fasciitis pain, while also loosening tight muscles, increasing flexibility, and building muscle strength in the foot.
Simple stretching techniques may incorporate stairs, walls, boards, and objects that the arch of the foot can be rolled over. Strengthening exercises may involve picking up small objects like marbles or coins with the toes. A physical therapist can show you how to perform specific exercises to stretch and strengthen your lower leg and foot muscles, which will help stabilize your ankle and heel.
Studies have shown that many plantar fasciitis patients cite stretching and strengthening exercises as the most helpful part of their treatment. (6)
Orthotics, or orthoses, are devices that are worn in a shoe or on the foot to manage pain and walking problems. They include foot pads or heel cups that cushion a sensitive area on the foot like a callus, and shoe inserts that provide support and correct ankle or heel movement.
Arch taping involves applying athletic tape to the foot to reduce stress on the ligament by keeping the fascia from moving too much. Some people tape their arch only before physical activity, while others apply the tape to reduce strain throughout the day.
Night splints are devices that gently stretch your calf and the arch of your foot. They are worn at night and work by supporting your foot with the toes pointing upwards while you sleep.
The American Academy of Orthopedic Surgeons recommends surgery for plantar fasciitis only if aggressive nonsurgical treatment has been attempted for 12 months and the condition persists or worsens. (8)
Surgical options include:
Surgical treatment for plantar fasciitis can be very effective and most patients have good results. But surgery can weaken the arch of the foot, and there is a risk of nerve damage.
There is another option for patients with chronic plantar fasciitis known as extracorporeal shockwave therapy (ESWT). This noninvasive procedure involves the use of high-energy sound waves directed at the area of pain to stimulate healing in damaged tissue.
ESWT does not require a surgical incision and complication rates are relatively low. But it can cause swelling, bruising, pain, or numbness. There is also some question as to how effective the treatment is. (9)
Additional reporting by George Vernadakis.
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