What Is the Best Treatment for Plantar Fasciitis?

Stretching exercises can help alleviate the pain of plantar fasciitis.

Plantar fasciitis is inflammation and pain in the heel area caused by irritation at the insertion of the fascia, a thick band of fibrous connective tissue at the bottom of the foot that runs from the heel to the toes.

It is a common condition that is sometimes called jogger's heel, tennis heel, or policeman's heel, and may be incorrectly referred to as heel spurs.

The main symptom of plantar fasciitis is pain beneath the heel on the sole of the foot. Pain may be present in one or both feet.

• The pain may be sharp and severe.
• It is usually worse in the morning or after sitting for long periods.
• Patients may limp.
• Pain tends to improve with activity but will worsen again after long periods on your feet.

Plantar fasciitis occurs when the plantar fascia -- a thick band of fibrous connective tissue at the bottom of the foot that runs from the heel to the toes -- is overly stretched and tears.

Risk factors for stretching and tearing the plantar fascia include the following:

• Participating in activities that cause repetitive impact to the heel such as running or dancing
  • Plantar fasciitis is very common in runners and it may be due to
    • overtraining or sudden increases in distance;
    • poorly fitted running shoes/worn out shoes (runners should replace shoes every 250-500 miles);
    • running on hard surfaces (concrete is harder than pavement, which is harder than dirt);
    • flat feet;
    • high arches;
    • improper athletic training;
    • obesity;
    • being female;
    • wearing high heels;
    • occupations requiring prolonged standing and weight-bearing;
    • limited ankle flexibility;
    • tight hamstrings or glutes;
    • structural problems with the foot/ankle: high or low arches, overpronation, leg-length discrepancy, excessive lateral tibial torsion, and excessive femoral anteversion;
    • aging and heel fat pad atrophy; and
    • rheumatic disorders such as ankylosing spondylitis or psoriatic arthritis.

A doctor will take a medical history and perform a physical exam of the feet. It's unnecessary to perform specific lab tests or imaging studies to diagnose plantar fasciitis, but doctors may need them to rule out other causes of heel pain, such as fractures, tumors, or arthritis.

Imaging tests may include

• X-rays,
• ultrasound,
• magnetic resonance imaging (MRI),
• bone scan,
• CT scan, and
• electromyography (EMG).

Blood tests may include

• complete blood count (CBC),
• erythrocyte sedimentation rate (ESR),
• complete metabolic panel, and
• rheumatoid factor studies.

The first line treatment for plantar fasciitis is usually conservative and involves the following:

• Resting, which means stopping or limiting athletic activities where there is repetitive heel impact
• Icing the area for 20 minutes up to four times daily, to help relieve pain
• Stretching exercises
• Over-the-counter (OTC) pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil, Motrin) or naproxen (Aleve)
• Wearing protective footwear such as athletic shoes, arch-supporting shoes, shoes with rigid shanks, or cushion-soled shoes with gel pad inserts or heel cups for temporary pain relief
• Orthotics to properly support the foot may help.
• Taping the foot with a technique called "low-Dye taping" may help.
• Splints worn overnight may be helpful to provide pain relief and a gentle stretch.
• Avoiding wearing slippers or going barefoot

If conservative measures fail to alleviate the pain caused by plantar fasciitis, other treatments are available:

• Physical therapy can help with long-term pain relief. Contrast baths, ultrasonography, and iontophoresis may be used along with PT.
• Steroid injections in the foot can relieve pain. The effect may wear off in a few weeks.
• Botulinum toxin type A injection may help with pain relief and overall foot function.
• Walking cast
• Surgery is rarely needed for plantar fasciitis and is only recommended when all other treatments have failed symptoms persist for at least 6 to 12 months.
  • Fasciotomy surgery involves detaching the plantar fascia from the heel bone.
  • Cryosurgery destroys damaged tissue.
  • Bipolar radiofrequency microdebridement applies a bipolar radiofrequency pulse to the plantar fascia.
• Autologous blood injection, platelet-rich plasma (PRP) injection, nitroglycerin patches, and extracorporeal shock-wave therapy (ESWT) are treatments designed to create an acute inflammatory reaction and restart the healing process.
• Extracorporeal shock wave therapy (ESWT) has not yet been shown to be effective, but it is approved by the Food and Drug Administration (FDA) to treat plantar fasciitis and may be recommended by some clinicians.

Potential complications of plantar fasciitis include

• chronic heel pain,
• flattening of the arch,
• plantar fascia rupture,
• arch strain, and
• heel numbness.
• The heel pain may affect the way you walk, which can lead to problems with the foot, knee, hip, or back.

The following tips can help prevent plantar fasciitis:

• Runners should run on soft surfaces, wear proper shoes (a running store can help with proper fit for your foot and gait), replace worn-out shoes, and increase mileage by no more than 10% per week.
• Maintain a healthy weight.
• Try low-impact sports and activities.
• Ice the heel to keep inflammation at bay.
• Regularly stretch the plantar fascia, Achilles tendons, and calf muscles.
• Don't walk barefoot.