Plantar Fasciitis - Treatment Overview

SYMPTOMS & TREATMENTS

The goals of treatment for plantar fasciitis are to:

Relieve inflammation and pain in the heel.
Allow small tears in the plantar fascia ligament to heal.
Improve strength and flexibility and correct foot problems such as pronation so that you don't stress the plantar fascia ligament.
Allow you to resume your normal activities.

About 8 out of 10 people recover completely within a year. Out of 100 people with plantar fasciitis, about 95 are able to relieve their heel pain with nonsurgical treatments. Only about 5 out of 100 need surgery.¹

Treatment that you start when you first notice symptoms is more successful and takes less time than treatment that is delayed.

Initial treatment

There are many methods you can try to relieve the heel pain of plantar fasciitis. Even though their effectiveness has not been proved in scientific studies, these methods, used alone or in combination, work for most people.²

Rest your feet. Limit or, if possible, stopdaily activities that are causing your heel pain. Try to avoid running orwalking on hard surfaces, such as concrete.
To reduce inflammationand relieve pain, putice on your heel. You can also try ananti-inflammatory drug such as ibuprofen (Advil orMotrin, for example), naproxen (Aleve, for example), or aspirin.
Wear shoes with good shock absorption and the right arch supportfor your foot. Athletic shoes or shoes with a well-cushioned sole are usuallygood choices.
Try heel cups or shoe inserts (orthotics ) to helpcushion your heel. You can buy these at many athletic shoe stores anddrugstores. Use them in both shoes, even if only one foothurts.
Put on your shoes as soon as you get out of bed.Going barefoot or wearing slippers may make your pain worse.
Do simple exercises such ascalf stretches andtowel stretches several times a day, especially when you first get up in themorning. These can help your ligament become more flexible and strengthen themuscles that support your arch. For more information, see:
Plantar fasciitis: Exercises to reduce pain.

Avoid using only heat on your foot, such as from a heating pad or a heat pack. Heat tends to make symptoms worse. If you use contrast baths, which alternate hot and cold water, make sure you end with a soak in cold water.

If your weight is putting extra stress on your feet, your doctor may encourage you to try a weight-loss program.

Ongoing treatment

If nonsurgical methods such as rest, ice, and stretching exercises help relieve your plantar fasciitis symptoms, continue using them. If you have not improved after 6 weeks, your doctor may recommend that you continue those methods but add other nonsurgical treatments, such as:

Custom-madeshoe inserts (orthotics ). Custom-made orthoticsrequire a prescription. If your foot has an unusual shape or if you have a certainproblem that the device will help, then a custom-made insert may fit better andcontrol pain better than a nonprescription one.
Night splints. A night splint holds the foot with thetoes pointed up and with the foot and ankle at a 90-degree angle. This positionapplies a constant, gentle stretch to the plantar fascia.
Awalking cast on the lower leg. Casting is somewhatmore expensive and inconvenient than other nonsurgical treatments. And afterthe cast is removed, you will need some rehabilitation to restore strength andrange of motion. But a cast forces you to rest your foot. Some people reportthat it is the most helpful of nonsurgical treatments.

Your doctor may recommend corticosteroid shots if you have tried nonsurgical treatment for several weeks without success.¹ Shots can relieve pain, but the relief is often short-term. Also, the shots themselves are painful, and repeated shots can damage the heel pad and the plantar fascia.

Treatment if the condition gets worse

If nonsurgical treatments for plantar fasciitis do not relieve your heel pain, you may need to try other treatments. These may include corticosteroid shots, custom shoe inserts, or a walking cast if you have not already tried one. Formal physical therapy instruction can help to ensure proper stretching of the Achilles tendon and plantar fascia ligament. Doctors usually consider surgery only for severe, persistent cases.

Out of 100 people with plantar fasciitis, about 95 are able to relieve their heel pain with nonsurgical treatments. Only about 5 out of 100 need surgery.¹ If you are one of the few people whose symptoms don't improve in 6 to 12 months with other treatments, your doctor may recommend plantar fascia release surgery. Plantar fascia release involves cutting part of the plantar fascia ligament in order to release the tension and relieve the inflammation of the ligament. For more information on surgery, see:

Plantar fasciitis: Should I have surgery for plantar fasciitis?

What To Think About

If you are trying to lose weight and you develop plantar fasciitis when you begin exercising, especially jogging, talk with your doctor about other types of activity that will support your weight-loss efforts without making your heel pain worse. An activity like swimming that doesn't put stress on your feet may be a good choice.

If your plantar fasciitis is related to sports or your job, you may have trouble stopping or reducing your activity to allow your feet to heal. But resting your feet is very important to avoid long-lasting heel pain. Your doctor or a sports medicine specialist may be able to suggest a plan for alternating your regular activities with ones that do not make your pain worse.

If you exercise frequently, ask your doctor questions about exercising during plantar fasciitis treatment. Or ask about whether physical therapy or referral to a sports medicine specialist, podiatrist, or orthopedist is appropriate.

Prevention

By:	Healthwise Staff	Last Revised: October 22, 2009
Medical Review:	William M. Green, MD - Emergency Medicine Barry L. Scurran, DPM - Podiatry and Podiatric Surgery

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