Conservative Treatment (Non-Surgical)

Because plantar fasciitis is so common, many physicians have developed their own protocols of conservative treatment for plantar fasciitis. Above all, treating plantar fasciitis requires patience. It may take months to resolve. The following are the most commonly prescribed conservative therapies.

Ice: Ice is a mainstay anti-inflammatory of acute injuries. Applying an ice compress for 15-20 minutes several times a day can reduce the inflammation and pain of plantar fasciitis. A bag of frozen vegetables works well as it is readily available and conforms to the heel. (Note of Safety: Diabetics and individuals with poor circulation and/or decreased sensation should not use ice or other forms of cold (or hot) therapy.)

Stretching: Daily stretching of the calf muscles can improve motion at the ankle joint and reduce stress on the plantar fascia. Gently stretching the plantar fascia before getting out of bed can greatly alleviate the pain experienced on the first few steps. In severe cases, doctors may prescribe night splints or even apply a short leg cast to keep the foot in a stretched position.

Heel Lift: Often combined with stretching exercises, a half-inch heel lift that is placed in the shoe decreases the amount of motion necessary at the ankle joint, reducing tension on the plantar fascia.

Physical Therapy: Range of motion exercises, ultrasound (with or without therapeutic additives), hydrotherapy (whirlpool), and deep massage of the affected area can all relieve the pain associated with plantar fasciitis.

Anti-Inflammatory Medications: Oral anti-inflammatory medications (such as Ibuprofen) or a Medrol Dose Pack (a tapering corticosteroid therapy) can reduce the inflammation and pain associated with plantar fasciitis.

Taping/Padding: Your physician may employ any number of taping and padding techniques designed to support the arch and alleviate undue strain on the plantar fascia. A decrease in pain from strapping is a good indication that orthoses will be beneficial.

Orthoses: Orthoses are inserts placed in your shoes that control abnormal motion and provide additional support to the arch. These devices may be over-the-counter (OTC) or prescriptive/custom molded. OTC devices are less durable and may not provide support at the exact location that would be of most benefit to the patient. Some doctors will try OTC orthoses first to gauge the effectiveness of the device before asking you to part with $300-400 for a pair custom molded to your feet.

Proper footwear: Orthoses are only as good as the shoes in which they are used. All too often, patients come to the office wearing shoes offering little or no support that would provide more benefit as a chew toy to the family dog. Discard the chew toys. Select shoes with good arch support and a firm heel counter-these shoe types are usually referred to as "motion controlling." If the shoe can be twisted as if you were wringing out a wet towel, then it probably will not provide the support you need. Ladies should avoid the traditional pointed-toe shoes and excessively high heels. If work demands fashionable shoes, a small heel may provide some benefit in controlling abnormal motion and maintaining the longitudinal arch.

Cortisone Injections: Local anesthetic and corticosteroid injected directly to the point of pain can provide immediate relief. The local anesthetic will numb the area, while the corticosteroid will decrease the inflammation. In some cases, patients experience a 'steroid flare' in which symptoms become worse within 24-48 hours of the injection. After this period, symptoms can improve greatly. Cortisone therapy may consist of one to three injections dispersed over time. Many athletes are aware that corticosteroid injections (not to be confused with the anabolic steroids used by some athletes) can result in spontaneous rupture of tendon. This is a risk with injection therapy-10% of patients in one study suffered rupture of the plantar fascia attributed to corticosteroid injection [1]. Still, many doctors consider cortisone safe and regularly use it for plantar fasciitis for even if rupture occurs, it will likely heal anyway.

Additional Advice: Massaging the affected area before getting out of bed and after long periods of rest can reduce the amount of pain. Resting the affected foot will allow the plantar fascia to recover quicker. Avoid bearing weight without some form of arch support and never walk barefoot.