Plantar fasciitis is painful inflammatory condition of the plantar fascia, the band of connective tissue that supports the arch of the foot. Plantar Fasciitis is a very common foot disorder that usually develops when the plantar fascia is excessively stretched or sprained.

Surgery for Plantar Fasciitis, called Plantar Fascia Release, is an option, but it is far from being the best option — it has a relatively long recovery period and, like any surgery, it has risks of complications such as infections or nerve damage. In fact, about 95% of Plantar Fasciitis cases recover without surgical intervention. Surgery should only be considered as the last option.

Fortunately, there are many other treatment options for Plantar Fasciitis that have an easier recovery, have less risks, and are actually more effective than surgery, particularly with an early intervention. In fact, many of these treatments have shown good results in the treatment of several musculoskeletal conditions besides Plantar Fasciitis and have been replacing traditional surgery for many orthopedic conditions. For most patients, non-surgical treatment of plantar fasciitis resolve the pain and the injury within a few months.

Let’s take a look at the top treatment options for Plantar Fasciitis.

Conservative Treatments

Conservative treatment should always be the first approach to the management of Plantar Fasciitis. There are several options that can be used in combination to control the inflammatory process, manage pain, prevent further injury, and support full healing. For many patients, particularly those with mild cases of Plantar Fasciitis and those who seek early intervention, conservative treatment is all that is needed.

Conservative treatments for Plantar Fasciitis include:

Rest

Plantar Fasciitis is most often caused by excessive use of and load on the plantar fascia. Therefore, it is important to minimize stress to the ligament. The best way to do so is rest. You may keep exercising, but activities with low impact on your feet should be preferred —choose bicycling or swimming over walking or running, for example.

Stretching

Stretching

Stretching

Stretching exercises are very effective in the majority of Plantar Fasciitis cases. Stretching helps strengthen the plantar fascia and increase the support to the ligament. Stretching exercises for Plantar Fasciitis are simple and can easily be done at home.

Massage

Massaging the plantar fascia is a good way to stretch and release tension from the tissue. It is helpful in alleviating pain, swelling, and discomfort caused by Plantar Fasciitis. Ice massage is an excellent option because it combines the benefit of stretching with the benefit of cold, quickly relieving you from discomfort and pain. It can be done at home by rolling your injured foot on a frozen water bottle, for example. Deep tissue massage to the heel and to the back of the calf muscles is also very helpful and a good option, but this should be performed by an expert.

Improved footwear / orthotics

Plantar Fasciitis Orhtotics

Plantar Fasciitis Orthotics

Footwear is a very important factor in the process of recovery from Plantar Fasciitis. Bad shoes can worsen Plantar Fasciitis. In fact, bad shoes can even be the initial cause of Plantar Fasciitis. Wearing well-cushioned, supportive shoes is helps reduce the stress you place on the plantar fascia while you stand or walk.

You can also upgrade your shoes using orthotics — specialized devices you insert in your shoes such as cups, cushions and insoles. Orthotics minimize stress to the plantar fascia by stabilizing the arch of your feet and by helping to absorb the load placed on your feet. You can buy generic over-the-counter orthotics but they may not have the best fit for your foot. Alternatively, you can get custom-made orthotics that are designed to specifically fit your foot.

Pain Medication

Pain Medication

Pain Medication

Pain killers do not treat Plantar Fasciitis. However, they help you manage pain, allowing you to carry out other treatments — stretching exercises or massage, for example — with less discomfort. Over-the-counter pain medications such as acetaminophen (Tylenol) or NSAIDs (non-steroidal anti-inflammatory drugs) used in combination with other conservative treatments can be very helpful in relieving pain.

Extracorporeal Shock Wave Therapy

Extracorporeal Shockwave Therapy (ESWT) is a non-invasive procedure that uses shock waves (sound waves) to promote tissue healing. This therapy is performed by applying sound waves to the injured area.

The repeated incidence of the sound waves is believed to induce microtraumas in the injured area of the plantar fascia; this attracts new blood vessels and chemical mediators that stimulate the healing process and promote the regeneration of the tissue.

Clinical trials studying the efficacy of Extracorporeal Shock Wave Therapy for Plantar Fasciitis treatment have reported beneficial effects, with the vast majority of cases showing significant pain relief and improvement in function.

Extracorporeal Shockwave Therapy has become one of the most successful and used therapies for musculoskeletal conditions. It allows for a fast recovery with good tolerability and minimal discomfort. Its use has been approved and recommended by orthopedic medicine associations worldwide.

Platelet-rich plasma injections

Platelet rich plasma (PRP) therapy is a regenerative therapy for Plantar Fasciitis that consists on the injection of your own platelets into the injured area. Platelets have an important role in wound and tissue healing and this property can be used to trigger the body’s natural repair and regeneration processes. Platelet rich plasma, a fraction that has a high concentration of platelets, is obtained using only a small amount of your own blood. PRP is then activated using light and injected into the plantar fascia to promote its healing. These activated platelets will exert beneficial effects through several mechanisms: they will stimulate natural regeneration processes via the activation and release of natural growth factors and they will trigger a local inflammatory reaction that will promote an increase in blood supply to the plantar fascia. PRP therapy usually requires only one session, but depending on the clinical characteristics of Plantar Fasciitis, there may be cases for which additional injections may be needed.

Ultrasound guided radiofrequency ablation

Ultrasound guided radiofrequency ablation is a sophisticated, minimally invasive, mostly painless procedure for Plantar Fasciitis. Radiofrequency ablation uses high frequency sound waves to heat the affected sensory nerve to 90 degrees Celsius. At this temperature, proteins in the nerve are broken down and the nerve is destroyed, which prevents the nerve fibers from transmitting pain from that area. Radiofrequency ablation can also stimulate the creation of new blood vessels, which accelerates the healing process.

For the procedure, skin is anesthetized with a local anesthetic and a very small puncture is made over the affected zone. The radiofrequency needle is then introduced with the aid of ultrasound guidance and the positioning of the needle is checked with a nerve stimulator. An electrode is then placed through the needle and heated according to the protocol. Recovery is quick and simple and side effects are rare. Normal daily activity can be resumed within one or two days.

It may take up to 4-6 weeks for the full effect of radiofrequency ablation to be felt, but most patients experience remarkable improvements within just a week. High patient satisfaction scores and long-term pain relief have been reported, especially for patients whose Plantar Fasciitis pain is due to Baxter’s Entrapment.

Ultrasound guided corticosteroid injections

Ultrasound guided corticosteroid injections can be helpful in cases that do not get adequate pain relief from conservative treatments. A corticosteroid injection can resolve pain for up to 4 weeks and minimize inflammation and swelling for up to 3 months. Using ultrasound guidance increases the accuracy of the injection, which is an important factor for its success. This procedure may have a few transient side effects, including numbness, pin and needle sensations and localized discomfort. Repeated corticosteroid injections are not usually recommended due to the risk of aggravating damage. Ultrasound guided corticosteroid injections should be used in combination with other conservative treatments such as orthotics and stretching exercises.

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Janet Pearl MD

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