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Plantar Fasciitis Treatment & Management

  • Author: Craig C Young, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: Oct 11, 2015
 

Approach Considerations

Understanding the etiology of the problem and directing treatment accordingly is the key to successful treatment of plantar fasciitis. Close attention must be paid during the history and physical examination to ensure that other potential causes of heel pain are not missed. An organized, evidence-based, stepwise approach to treatment will help achieve good outcomes. Also essential is educating the patient about the expected time of recovery.

Plantar fasciitis is typically a self-limited condition, and studies have reported a resolution incidence of up to 90% with nonsurgical measures.[23, 34, 33, 35, 36, 37] However, patients have differing degrees of pathology and varying types of body habitus and lifestyle and will therefore respond differently to various treatments. Even with individualized care, some patients respond quickly, and others exhaust all conservative measures before relief is achieved.

The major component contributing to discomfort is the irritation occurring secondary to the disease process, rather than a spur or other mechanical factor. Traditional therapeutic efforts have been directed at decreasing the presumed inflammation. These treatments include icing, nonsteroidal anti-inflammatory drugs (NSAIDs), rest and activity modification, corticosteroids, botulinum toxin type A, splinting, shoe modifications, and orthoses.

Other treatment techniques have been directed at resolving the degeneration caused by the disease process. In general, these techniques are designed to create an acute inflammatory reaction with the goal of restarting the healing process. These techniques include autologous blood injection, platelet-rich plasma (PRP) injection, nitroglycerin patches, extracorporeal shock-wave therapy (ESWT), and surgical procedures. Formal physical therapy can include components that target both goals.

It is important to note that these treatment modalities are to be used in combination, as components of a multimodal therapeutic approach. Such an approach can be challenging, in that it places high expectations on the patient with respect to responsibility, consistency, and compliance. If these expectations are met, the chances of success are good.

Traditional treatment algorithms usually begin with 6 weeks of consistent and daily icing, stretching, NSAID therapy, strapping and taping, and over-the-counter (OTC) orthoses. Counseling as to activity modification, as well as choice of shoe gear, is important. After 6 weeks, recalcitrant cases should be treated additionally with a night splint and, possibly, an injection, along with the initial regimen for another 6 weeks.

If pain persists, referral to a foot and ankle specialist should be considered. Injection therapy, immobilization in a cast or walker boot, physical therapy, and custom orthotics can be employed under more controlled supervision. For severe recalcitrant cases, surgical intervention may ultimately be required.

A study looked to determine whether initial clinical findings could help predict patient response to conservative treatment primarily consisting of supportive footwear and stretching. The study reported that patients with severe ankle equinus were nearly four times more likely to experience a favorable response to treatment centered on home Achilles tendon stretching and supportive therapy.[38]

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Icing

Ice is a first-line anti-inflammatory treatment for plantar fasciitis, especially for athletes. Icing should be performed after completing exercise, stretching, and strengthening, and this treatment can be applied via ice massage, ice bath, or ice pack, as follows:

  • For ice massage, the patient freezes water in a small paper or polystyrene cup and then rubs the ice over the painful heel, using a circular motion and moderate pressure for 5-10 minutes.
  • For an ice bath, a shallow pad is filled with water and ice, and the patient soaks the heel for 10-15 minutes; to prevent cold injuries, neoprene toe covers should be used, or the toes should be kept out of the ice water
  • For an ice pack, crushed ice is placed in a plastic bag wrapped in a towel, then applied for 15-20 minutes; the use of crushed ice allows the pack to be molded to the foot, thereby increasing the contact area (a bag of prepackaged frozen corn kernels wrapped in a towel is a good alternative)
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Rest and Activity Modification

Rest is critical to the treatment of plantar fasciitis. This includes activity modification or a level of relative rest; complete rest may not be practical, particularly for more active individuals and for those whose jobs require standing. Alternative exercises or avoidance of inciting activities will increase the success rate of pain relief and of patient compliance. In patients with severe pain, a period of casting or immobilization in a walker boot may be necessary. In one study, 25% of patients considered rest to be the most effective form of treatment.[23]

Athletes with plantar fasciitis may return to activities as limited by their symptoms. However, they must modify activities that can aggravate plantar fasciitis (eg, walking, running, and jumping); such modifications may be as simple as decreasing the amount, frequency, or intensity of the inciting activity or activities. Athletes are more compliant with a decreased level of activity if they are allowed to increase other nonaggravating activities.[39]

The physician might need to plan a strict activities regimen because many athletes tend to ignore pain during activity. Generally, athletes should start at 50% of their usual distance or time with a gradual increase of activity by approximately 10% per week.

The following recommendations are appropriate for runners:

  • Replacing worn-out shoes and selecting appropriate shoes are also important; runners should replace shoes every 250-500 miles (400-800 km) to maintain optimum shoe cushioning [19]
  • Runners who overpronate and who have pes planus should select motion-control shoes, which typically feature a straight-lasted, board-lasted, or combination-lasted construction; an external heel counter; a wider flare; and extra medial support. [19]
  • Runners who have pes cavus should select shoes that have greater cushioning properties
  • All distance runners should practice in training flats that are better cushioned, reserving the lighter and less well-cushioned racing flats for competition.
  • Runners whom are considering starting barefoot running style programs should be cautioned to start these runs at lengths and intensities as if they are beginning runners.
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Pharmacologic Therapy

NSAIDs

Anti-inflammatory medications are frequently used to treat plantar fasciitis. Although there is controversy as to whether NSAIDs actually assist in the physiologic healing process, these agents can be useful as an adjunct for controlling pain while the individual’s plantar fasciitis is being treated with stretching, strengthening, and relative rest.[40, 23]

In one study, 79% of patients were successfully treated with NSAIDs.[23] The key to NSAID therapy is consistent, daily dosing throughout the acute phase of treatment. Risks such as gastrointestinal (GI) sequelae, gastric pain, and renal damage have been well documented.[41] Use NSAIDs with caution in elderly patients, monitoring for the most common adverse effects and for any drug interactions. Oral NSAIDs should be avoided during pregnancy.

Corticosteroids

Corticosteroids can be administered either orally or via injections. Oral preparations, such as a methylprednisolone dose pack, are distributed systemically and can be used in the acute phase in conjunction with, or in place of, NSAIDS.

Corticosteroid injections, on the other hand, involve local, concentrated administration and are generally reserved as a tertiary level of treatment after failure of other primary conservative measures (eg, stretching, shoe inserts, or orthoses) in severe recalcitrant cases.[42, 43, 44] Whether or not injected corticosteroids alter the long-term pathology of chronic inflammation, many patients experience acute symptomatic improvement.[40, 45, 46] One study found that ultrasound (US)-guided steroid injection provided short-term relief from pain in plantar fasciitis for up to 4 weeks and improvement in plantar fascia swelling for up to 12 weeks.[47] Whether or not the use of ultrasound guidance improves outcome of corticosteroid injections is unknown at this time.[48, 49, 50]

Before steroids are injected, potential causes of heel pain other than plantar fasciitis should also be considered, and a plain radiograph of the foot or calcaneus should always be obtained.

A corticosteroid injection may be given through a plantar or a medial approach, with or without ultrasound guidance, typically in conjunction with a local anesthetic. The basic technique may be briefly summarized as follows:

  • Use a 22-gauge, 1.5-in. (3.8-cm) needle containing a mixture of 4 mL of local anesthetic (eg, lidocaine) and 1 mL (40 mg) of corticosteroid (eg, methylprednisolone)
  • Palpate the most anterior aspect of the medial plantar calcaneal tubercle, and insert the needle at this site
  • Advance the needle until it reaches the most anterior (distal) aspect of the plantar medial calcaneal tuberosity
  • When the proximal (anterior) edge of the heel spur has been identified, advance the needle immediately anterior to this spot
  • Avoid injecting within the superficial layers of the subcutaneous tissue, because corticosteroid injection into the superficial fat pad can cause fat necrosis and atrophy, which reduce the shock-absorbing capacity of the plantar heel

Studies have reported success rates of 70% or better.[51, 34] Corticosteroid injections have been shown to improve symptoms at 1 month but not at 6 months. It is recommended not to give more than 3 steroid injections within a year.

A randomized, controlled study demonstrated that intralesional corticosteroid injection is more efficacious and more cost-effective than low-energy ESWT in the treatment of plantar fasciitis that has persisted for more than 6 weeks.[52]

In a preliminary report, a posterior tibial nerve block prior to steroid injection was shown to decrease the pain from injection and to improve compliance with treatment, without any complications.[53]

Trials of ultrasound-guided steroid injection have shown its potential efficacy. This approach has been shown to produce a good clinical response when palpation-guided injection is unsuccessful.[51] Accurate injection under ultrasonographic guidance may also minimize adverse effects from the injection.[54]

A study of 25 patients who received corticosteroid injections for plantar fasciitis showed that patients received symptomatic relief as measured by tenderness threshold and a visual analog scale (VAS).[54] Although this benefit was obtained whether the injection was performed with imaging (ultrasound) guidance or with palpation alone, patients receiving image-guided injections had a lower rate of recurrence of heel pain. Thus, although injection is helpful with or without imaging guidance, the use of imaging may provide additional benefit.

The general risks involved with the use of corticosteroids include skin atrophy, skin hypopigmentation, soft-tissue atrophy, infection, bleeding, and failure to work. A steroid flare-up, which consists of increased pain for up to several days, may occur in up to 2% of individuals who use corticosteroids.[45]

Potential risks of corticosteroid injection include plantar fascia rupture, which was found in almost 10% of patients after plantar fascia injection in one case series,[28] and fat pad atrophy.[28, 29] Long-term sequelae were found in approximately 50% of patients with plantar fascia rupture.[28]

Improper placement of a corticosteroid injection for plantar fasciitis can result in necrosis and atrophy of the plantar fat pad at the heel. This complication may result in significant pain and a decreased activity level for the patient.

Bleeding or bruising generally is expected only in patients who have bleeding disorders or are taking anticoagulants. Infection at the injection site is rare, but possible. In addition to the sterile technique for the procedure itself, patients need to maintain good foot hygiene after the injection. Allergic reactions to the injected medications are rare, but possible.

Intravascular injection could potentially cause cardiac dysfunction as a consequence of the inherent toxicity of local anesthetic agents. Peripheral nerve dysfunction is possible if the local anesthetic is injected either close to or within the medial plantar nerve or the calcaneal branch of the tibial nerve.

In diabetic patients, transient elevation of blood glucose levels may occur after corticosteroid injection. Corticosteroid injection can be performed during pregnancy, although safety for use during pregnancy has not been established. With pediatric patients, obtain informed consent from the parent or legal guardian before proceeding with examination or any injection.

Patients should be informed that the symptomatic improvement from the corticosteroid usually does not begin to take effect until a few days after the injection. They may experience a transient, mild increase in symptoms when the effect of the short-term local anesthetic has ended, but the long-term corticosteroid effect has not yet begun.

Finally, they should be educated to watch for any signs or symptoms of local infection at the injection site, while maintaining good skin hygiene.

Botulinum toxin type A

A short-term, randomized, controlled, double-blind study found that botulinum toxin type A injection appeared to yield significant improvements in pain relief and overall foot function.[55] Another study found that ultrasound-guided injection of botulinum toxin type A did not induce the complication of fat pad atrophy but was successful at improving the maximal center of pressure loading in the foot.[56] A randomized, double-blind control study of 50 patients with plantar fasciitis compared the injection of botulinum toxin type A injection to saline. There was significant improvement in VAS pain scores and plantar fascia thickness at both the 3-week and the 3-month follow-up visit.[56] A 6-month, randomized, controlled, double-blind study compared botulinum toxin type A injection to corticosteroid injection in 36 patients and found more rapid and sustained response in the botulinum toxin–injected group.[57]

Autologous blood and plasma

Injection of autologous blood into the plantar fascia origin is thought to stimulate an acute inflammatory reaction, providing factors that stimulate fibroblast activity and vascular growth and thereby lead to reinitiation of the healing process. This treatment has been shown to be effective in limited studies of chronic inflammatory musculotendinous conditions.[58, 59, 60]

There is some evidence to suggest that platelet-rich plasma may be beneficial in the treatment of chronic plantar fasciitis.[61, 62, 63] Although both autologous blood and PRP injections appear to cause resolution of the symptoms of plantar fasciitis, these studies have shown results that are not significantly different when compared corticosteroid injections.[64, 65]

Cryopreserved human amniotic membrane

One newer, experimental treatment involves the injection of cryopreserved human amniotic membrane. This fetal tissue is believed to contain growth factors, cytokines, and matrix components, which promote soft tissue healing. A randomized, controlled, double-blind, pilot study of 23 patients found equivalent results to the control group, which had been injected with corticosteroid, at the 12 week follow-up.[66]

 

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Extracorporeal Shock-Wave Therapy

ESWT has been proposed as a treatment option for plantar fasciitis. The therapy bombards the tissue with high-pressure sound waves with its mechanism of action being to (1) stimulate blood flow for a beneficial immune response, (2) reinjure tissue to stimulate healing, and (3) shut down the neuronal pain pathways through the pulses hitting the affected nerves.

Although ESWT has not been definitively shown to be effective, it has been approved by the US Food and Drug Administration (FDA) for the treatment of plantar fasciitis and tennis elbow. ESWT is noninvasive, has few adverse side effects, and is associated with a good recovery time in patients with chronic plantar fasciitis; however, it is not covered by most insurance plans.

In 2013, two meta-analyses concluded that ESWT could be a safe and effective nonsurgical treatment for plantar fasciitis.[67, 68] Some studies show favorable results with ESWT but recommend that it be used only after other noninvasive, proven measures have failed.[69] Although multiple studies have shown success rates of 50-90%,[70, 71, 72, 73] overall, study results have been mixed.[74, 75, 69, 76, 77, 42, 43]

One study used low-frequency electrical stimulation to safely treat pain and increase functional activity levels in patients with plantar fasciitis.[78, 79]

Another study showed that ESWT induces an immediate analgesic and anti-inflammatory effect, as well as long-term tissue regeneration. ESWT has been observed to increase blood flow in the treated area, and preliminary data indicate increased endothelial nitric oxide levels as the mechanism. After 4-8 weeks of treatment, ESWT was also found to increase neoangiogenesis in the tendons of dogs; further research in this area is needed.[80]

Focused ESWT seems to be superior to radial ESWT.[81] However, a study that compared shockwave treatment with conventional physiotherapy for treating plantar fasciitis showed that whereas shockwave treatment yielded earlier pain reduction and functional improvement, it was no more effective than conventional physiotherapy 3 months after the end of treatment.[82]

In 2013, three different meta-analysis studies concluded that ESWT was effective compared to placebo.[83, 84, 85]

A pilot study suggests that intracorporeal pneumatic shock treatment (IPST) may be used in patients with chronic plantar fasciitis that does not respond to conservative management. IPST may be considered before surgery when ESWT devices are not available. A randomized, double-blind, prospective clinical pilot study showed that IPST is safe and effective; however, the exact mechanism is unknown and thus warrants further research.[86]

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Splints and Orthoses

Night splints

Most people naturally sleep with their feet in a plantar-flexed position, which causes the plantar fascia to be shortened. Night splints maintain a neutral 90° foot-leg angle and provide constant passive stretching of the Achilles tendon and plantar fascia.[87] Their effectiveness is believed to derive from the rest and healing provided by the constant stretching. In addition, the passive stretching helps prevent microtrauma at the plantar fascia–bone interface with the first steps out of bed in the morning.

A night splint can be molded from either plaster or fiberglass casting material, or a prefabricated and commercially produced plastic brace can be used (see the image below).

Night splint, designed to prevent shortening of Ac Night splint, designed to prevent shortening of Achilles tendon and plantar fascia at night.

A number of studies have shown that a high percentage of patients using night splints had improvement of their plantar fasciitis.[88, 89, 90, 91, 92, 93] Regarding the difficulty of patient compliance with night splints, a prospective trial showed that the comfort afforded by the night splint resulted in 95% patient compliance.[92] Some studies suggest that the splints are especially useful in individuals who have had symptoms of plantar fasciitis for longer than 12 months.[88, 89, 90, 91]

Casts or splints holding the ankle in neutral to slight dorsiflexion have been investigated, although their efficacy remains to be determined.

Shoe modifications and orthotics

A supportive heel counter and stiff midsole are important components of any shoe for those experiencing heel pain. Fashionable shoe wear often does not provide sufficient support for the arch and further exacerbates the problem. In general, lace-up shoe gear is recommended to maximize support. In one study,[23] 14% of patients credited change in shoe gear as the best treatment.

Shoe inserts (see the images below) can be used with existing shoes. Orthoses may be purchased over the counter or can be custom made. In general, over-the-counter (OTC) and custom-made orthoses appear to be equally effective in treating plantar fasciitis.[94, 95, 96, 97, 87, 98] However, one randomized, controlled trial found that ethylene vinyl acetate (EVA) prefabricated inserts may be more beneficial than custom-made ones in uncomplicated plantar fasciitis.[99] A randomized, prospective study found that more supportive orthotics resulted in better pain relief when compared with softer, non-supportive orthotics.[100]

Example of arch support with cushioned heel. These Example of arch support with cushioned heel. These are available in three-quarter or full lengths to fit in shoe.
Orthosis Orthosis

Patients with low arches experience increased stress on the plantar fascia with foot strike and have a decreased ability to absorb the forces that are generated by foot strike.[19] Mechanical corrections for pes planus include taping of the arches, OTC arch supports, and custom orthotic devices. Studies have found significant benefit to these conservative treatments when they are used in appropriate patients.[23, 101, 98, 102]

Low-dye strapping with athletic tape (see the image below) can be used as a definitive treatment or as a trial to determine whether the expense of arch supports or orthotics is worthwhile. Taping may be more cost-effective for the acute onset of plantar fasciitis, whereas OTC arch supports and orthotics may be more cost-effective for chronic or recurrent cases of plantar fasciitis and for the prevention of injuries. Heel pads are widely used, but they are generally useful only for shock absorption and do not provide support or structural control.[103] A meta-analysis concluded that kinesiotaping was no more effective than standard taping techniques.[104]

Low-dye taping method. This technique provides sup Low-dye taping method. This technique provides support for plantar fascia and helps reduce excessive pronation.

OTC arch supports usually last a full athletic season; custom orthotic devices should last many seasons. OTC arch supports are especially useful in athletes with acute plantar fasciitis and mild pes planus, particularly adolescents whose rapid foot growth may necessitate the purchase of 1 or more new pairs of arch supports per season.

Custom orthotic devices are designed to control biomechanical risk factors such as pes planus, valgus heel alignment, and leg-length discrepancies. Athletes treated with orthotic devices usually require semirigid, three-quarter to full-length orthotic devices with longitudinal arch support to control overpronation and metatarsal head motion, especially of the first metatarsal head.[105] The main disadvantage to the use of orthotic devices is the cost, which ranges from $75 to $300 or more; frequently, these devices are not covered by insurance.

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Physical Therapy

As a second level of treatment, formal physical therapy can help get the patient obtain long-term pain relief if he or she is unable to do so on his or her own. Contrast baths, ultrasonography, and iontophoresis may be used as adjuncts. In one study, iontophoresis was found to increase the speed of resolution of plantar fasciitis, though it had no effect on long-term outcome.[106]

For convenience, physical therapy programs may be divided into stretching, strengthening, and maintenance phases.

Stretching

The initial physical therapy program for plantar fasciitis emphasizes stretching of the calf and foot. Although the exact benefits are unknown,[107] one study found that 83% of patients treated with stretching exercises experienced successful relief.[23] Accordingly, stretching of the Achilles tendon has become a key component in the resolution of heel pain.

Wall stretching (the runner’s stretch) with the knee in both the extended and flexed positions, stair stretching, and towel stretching are all commonly employed. To perform a wall stretch, the patient stands 3 feet from a wall, placing the hands on the wall. Keeping the toes pointed straight and the heel on the ground, the patient leans the hips toward the wall, then holds this position for 30-40 seconds (see the image below).[7]

Calf stretch. Calf stretch.

Stretches targeted at the plantar fascia (see the image below) are particularly important. A level 2 clinical trial led by DiGiovanni et al studied the effect of passive dorsiflexion on the toes with simultaneous stretching of the Achilles tendon.[108] Recruiting the extension of the toes and subsequently engaging the windlass mechanism increased the effectiveness of the traditional stretching regimen, as well as subsequent symptom relief.

Plantar fascia stretching exercise. Plantar fascia stretching exercise.

Strengthening

A strengthening program that emphasizes intrinsic foot muscle strengthening has also proved beneficial.[24] . Exercises to strengthen the intrinsic muscles include towel curls, marble (or coin) pickups, and toe taps.[7]

For a towel curl, the patient sits with the affected foot lying flat on the end of a towel that is placed on a smooth surface, then pulls the towel toward the body by using the toes to curl up the towel while keeping the heel on the floor (see the image below). As the patient’s ability to perform this exercise improves, weight may be added to the far end of the towel to increase the difficulty.

Towel curl. Towel curl.

For marble pickups, the patient places a few marbles on the floor near a cup, picks them up with the toes, and drops them in the cup while keeping the heel on the floor. To provide a greater challenge, coins may be substituted for the marbles.

For toe taps, the patient lifts all the toes off the floor and, while keeping the heel on the floor and the outside 4 toes in the air, repetitively taps just the big toe to the floor (see the image below). Next, the patient reverses the process and repetitively taps the outside 4 toes to the floor while keeping the big toe in the air.

Toe taps. Toe taps.

Maintenance

To minimize the chances of that plantar fasciitis will recur, athletes should continue on a maintenance program of daily stretching or strengthening at least 2-3 times per week.

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Fasciotomy

In 5-10% of cases of plantar fasciitis, surgery may be required.[35, 34, 36, 109] It is reserved for those in whom a thorough 6-12 months of conservative treatment has failed. Plantar fascia release—performed by sectioning part or all of the fascia via an open or endoscopic procedure—has been the mainstay of treatment.[110, 111] However, partial and, especially, total release of the plantar fascia results in instability of the medial column of the foot, along with lateral column overload and pain.[112]

Overall, surgical release has a 70-90% success rate in treating patients with this condition.[113, 114, 115, 116, 117, 118, 119] A study by Bazaz and Ferkel found that endoscopic plantar fascia release provided significantly improved outcomes for patients, specifically those with less severe symptoms.[120]

Potential complications of surgical intervention include flattening of the longitudinal arch and heel hypoesthesia, in additions to the complications associated with plantar fascia rupture and corticosteroid injections. Longitudinal arch strain appears to account for over 50% of the chronic complications.[28, 29]

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Percutaneous Procedures

Percutaneous partial fasciotomy

In a series of 55 patients, percutaneous variation of medial fascial release appeared to have similar long-term pain outcomes to open fasciotomy with quicker return to activity.[121]

Cryosurgery

Cryosurgery is a relatively new technique in which a small cryoprobe is inserted percutaneously and used to destroy pathologic tissue or cells at temperatures reaching -70° C. A prospective study of 61 cases suggests that this modality is an effective treatment for plantar fasciitis after failed conservative management.[122] A larger study of study of 137 feet reported a 77% success rate with cryosurgery at 2-year follow-up.[123]

Bipolar radiofrequency microdebridement

Another relatively new percutaneous technique is Topaz bipolar radiofrequency microdebridement, which applies a bipolar radiofrequency pulse to the plantar fascia. In comparison to traditional surgical interventions, this new technology has been yielding equivalent results, with the advantages of decreased morbidity, earlier pain relief, lack of wound infection, absence of lateral column pain, and earlier time to weight-bearing.

In one study, patients achieved an average American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score of 92 out of a possible 105 at an average of 11 months after operation.[124] In another small study of 31 feet, radiofrequency nerve ablation resulted in significant improvement in VAS scores at 1 week, 1 month, 3 month, and 6 months.[125] Long-term, randomized, double-blind studies are still needed. As with any surgical procedure, the risk-benefit ratio must be determined.

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Prevention

Education is the single most important means of preventing plantar fasciitis. Instruct athletes with plantar fasciitis to warm up sufficiently before initiating activity, continue stretching programs, and ice down after activity. Patients may need to decrease their running temporarily; later, they may resume their earlier level of activity at the discretion of the physician and physical therapist.

Make sure that sports-minded patients wear appropriate shoes and change to a new pair every 250-500 miles (400-800 km).[19] Alternating between 2 pairs of shoes seems to help some athletes by allowing the cushioning in the shoes to recover more completely between runs. Adequate padding, proper sole stiffness, and appropriate arch support all can help alleviate symptoms.

In cases of occupationally related plantar fasciitis, evaluation of the worker’s shoes and work environment is essential for preventing a recurrence of this musculoskeletal condition.[18]

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Long-Term Monitoring

In general, patients should return for reevaluation no sooner than 2 months after the initial evaluation and implementation of a rehabilitation program since progress is typically slow. Occasionally, patients requiring more aggressive treatment because of severe disruption of their athletic, occupational, or recreational activities may need to be seen more frequently, mainly so that the caregiver can provide reassurance and chart the progress of therapeutic interventions.

At the time of follow-up, assess the therapeutic response to the corticosteroid injection, and evaluate for any complications.

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Contributor Information and Disclosures
Author

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

Gregory C Berlet, MD, FRCS(C) Clinical Assistant Professor of Orthopedics, Chief of Foot and Ankle Surgery, Department of Orthopedic Surgery, Ohio State University College of Medicine and Public Health

Gregory C Berlet, MD, FRCS(C) is a member of the following medical societies: American Medical Association, American Orthopaedic Foot and Ankle Society, Canadian Medical Association, Canadian Orthopaedic Association, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Jason H Calhoun, MD, FACS Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association

Disclosure: Nothing to disclose.

William T DeCarbo, DPM Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center

William T DeCarbo, DPM is a member of the following medical societies: American College of Foot and Ankle Surgeons and American Podiatric Medical Association

Disclosure: Nothing to disclose.

James K DeOrio, MD Director of Foot and Ankle Fellowship Program, Assistant Professor of Orthopedic Surgery, Orthopedic Surgery, St Lukes Hospital, Jacksonville, Florida

James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Florida Medical Association, and German Society of Neurology

Disclosure: Nothing to disclose.

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

Joseph P Garry, MD, FACSM, FAAFP Associate Professor, Sports Medicine Faculty, Department of Family & Community Medicine, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group

Disclosure: Nothing to disclose.

Shepard R Hurwitz, MD Executive Director, American Board of Orthopaedic Surgery

Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Christopher F Hyer, DPM, FACFAS Foot and Ankle Surgeon, Director, Advanced Foot and Ankle Surgery Fellowship, Orthopedic Foot and Ankle Center

Christopher F Hyer, DPM, FACFAS is a member of the following medical societies: American College of Foot and Ankle Surgeons and American Podiatric Medical Association

Disclosure: Wright Medical Technology Consulting fee Consulting; Wright Medical Technology Royalty Consulting; Orthopaedic Research and Education Foundation Grant/research funds Co-Investigator

Rick Kulkarni, MD

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Leslie Milne, MD Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine

Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Mark A Silverberg, MD, FACEP, MMB Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn

Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Deepika Singh, MD Staff Physician, Department of Emergency Medicine, Lawrence and Memorial Hospital, New London, CT

Deepika Singh, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Nurses Association, Emergency Medicine Residents Association, and Sigma Theta Tau International

Disclosure: Nothing to disclose.

Matthew D Sorensen, DPM Foot and Ankle Surgeon, Summit Orthopedics

Matthew D Sorensen, DPM is a member of the following medical societies: American College of Foot and Ankle Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell D White, MD Professor of Medicine, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

References
  1. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004 May. 25(5):303-10. [Medline].

  2. Tong KB, Furia J. Economic burden of plantar fasciitis treatment in the United States. Am J Orthop (Belle Mead NJ). 2010 May. 39(5):227-31. [Medline].

  3. Singh D, Angel J, Bentley G, Trevino SG. Fortnightly review. Plantar fasciitis. BMJ. 1997 Jul 19. 315(7101):172-5. [Medline]. [Full Text].

  4. Lennard TA. Fundamentals of procedural care. Lennard TA, ed. Physiatric Procedures in Clinical Practic. Philadelphia: Hanley & Belfus; 1995. 1-13.

  5. Williams PL, Warwick R. Myology. Gray’s Anatomy. Philadelphia: WB Saunders; 1980. 36: 612-613.

  6. HICKS JH. The mechanics of the foot. II. The plantar aponeurosis and the arch. J Anat. 1954 Jan. 88(1):25-30. [Medline]. [Full Text].

  7. Young CC, Rutherford DS, Niedfeldt MW. Treatment of plantar fasciitis. Am Fam Physician. 2001 Feb 1. 63(3):467-74, 477-8. [Medline]. [Full Text].

  8. Boberg J, Dauphinee D. Plantar Heel. Banks AM, Downey D, Martin S, Miller. McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery. 3. Philadelphia: Lippincott Williams & Wilkins; 2001. 1: 471.

  9. Woelffer KE, Figura MA, Sandberg NS, Snyder NS. Five-year follow-up results of instep plantar fasciotomy for chronic heel pain. J Foot Ankle Surg. 2000 Jul-Aug. 39(4):218-23. [Medline].

  10. Sammarco GJ, Helfrey RB. Surgical treatment of recalcitrant plantar fasciitis. Foot Ankle Int. 1996 Sep. 17(9):520-6. [Medline].

  11. Khan KM, Cook JL, Kannus P, Maffulli N, Bonar SF. Time to abandon the "tendinitis" myth. BMJ. 2002 Mar 16. 324(7338):626-7. [Medline]. [Full Text].

  12. Khan KM, Cook JL, Bonar F, Harcourt P, Astrom M. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med. 1999 Jun. 27(6):393-408. [Medline].

  13. Alfredson H, Lorentzon R. Chronic Achilles tendinosis: recommendations for treatment and prevention. Sports Med. 2000 Feb. 29(2):135-46. [Medline].

  14. Chen H, Ho HM, Ying M, Fu SN. Association between plantar fascia vascularity and morphology and foot dysfunction in individuals with chronic plantar fasciitis. J Orthop Sports Phys Ther. 2013 Oct. 43(10):727-34. [Medline].

  15. Tasto JP. The Use of Bipolar Radiofrequency Microtenotomy in the Treatment of Chronic Tendinosis of the Foot and Ankle. J Tech Foot Ankle Surg. 2006. 5(2):110-116.

  16. Cavanagh PR, Lafortune MA. Ground reaction forces in distance running. J Biomech. 1980. 13(5):397-406. [Medline].

  17. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003 May. 85-A(5):872-7. [Medline].

  18. Werner RA, Gell N, Hartigan A, Wiggerman N, Keyserling WM. Risk factors for plantar fasciitis among assembly plant workers. PM R. 2010 Feb. 2(2):110-6; quiz 1 p following 167. [Medline].

  19. Reid DC. Running: injury patterns and prevention. Sports Injury Assessment and Rehabilitation. New York, NY: Churchill Livingstone; 1992. 1131-58.

  20. Pohl MB, Hamill J, Davis IS. Biomechanical and anatomic factors associated with a history of plantar fasciitis in female runners. Clin J Sport Med. 2009 Sep. 19(5):372-6. [Medline].

  21. Bolívar YA, Munuera PV, Padillo JP. Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis. Foot Ankle Int. 2013 Jan. 34(1):42-8. [Medline].

  22. Moseley JB Jr, Chimenti BT. Foot and ankle injuries in the professional athlete. Baxter DE, ed. The Foot and Ankle in Sport. St. Louis, Mo: Mosby-Year Book; 1995. 321-8.

  23. Wolgin M, Cook C, Graham C, Mauldin D. Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int. 1994 Mar. 15(3):97-102. [Medline].

  24. Martin RL, Irrgang JJ, Conti SF. Outcome study of subjects with insertional plantar fasciitis. Foot Ankle Int. 1998 Dec. 19(12):803-11. [Medline].

  25. The diagnosis and treatment of heel pain. J Foot Ankle Surg. 2001 Sep-Oct. 40(5):329-40. [Medline].

  26. Bolivar YA, Munuera PV, Padillo JP. Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis. Foot Ankle Int. 2013 Jan. 34(1):42-8. [Medline].

  27. De Garceau D, Dean D, Requejo SM, Thordarson DB. The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int. 2003 Mar. 24(3):251-5. [Medline].

  28. Acevedo JI, Beskin JL. Complications of plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. 1998 Feb. 19(2):91-7. [Medline].

  29. Sellman JR. Plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. 1994 Jul. 15(7):376-81. [Medline].

  30. McMillan AM, Landorf KB, Barrett JT, Menz HB, Bird AR. Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis. J Foot Ankle Res. 2009 Nov 13. 2:32. [Medline]. [Full Text].

  31. Mahowald S, Legge BS, Grady JF. The correlation between plantar fascia thickness and symptoms of plantar fasciitis. J Am Podiatr Med Assoc. 2011 Sep. 101(5):385-9. [Medline].

  32. DiMarcangelo MT, Yu TC. Diagnostic imaging of heel pain and plantar fasciitis. Clin Podiatr Med Surg. 1997 Apr. 14(2):281-301. [Medline].

  33. Barrett SL, Day SV, Pignetti TT, Egly BR. Endoscopic heel anatomy: analysis of 200 fresh frozen specimens. J Foot Ankle Surg. 1995 Jan-Feb. 34(1):51-6. [Medline].

  34. Furey JG. Plantar fasciitis. The painful heel syndrome. J Bone Joint Surg Am. 1975 Jul. 57(5):672-3. [Medline].

  35. Gill LH, Kiebzak GM. Outcome of nonsurgical treatment for plantar fasciitis. Foot Ankle Int. 1996 Sep. 17(9):527-32. [Medline].

  36. Davis PF, Severud E, Baxter DE. Painful heel syndrome: results of nonoperative treatment. Foot Ankle Int. 1994 Oct. 15(10):531-5. [Medline].

  37. McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain--plantar fasciitis: clinical practice guildelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008 Apr. 38(4):A1-A18. [Medline].

  38. Wrobel JS, Fleischer AE, Matzkin-Bridger J, Fascione J, Crews R, Bruning N, et al. Physical examination variables predict response to conservative treatment of non-chronic plantar fasciitis: Secondary analysis of a randomized placebo controlled footwear study. PM R. 2015 Sep 23. [Medline].

  39. Quillen WS, Magee DJ, Zachazewski JE. The process of athletic injury and rehabilitation. Athletic Injuries and Rehabilitation. Philadelphia, Pa: WB Saunders Co; 1996. 3-8.

  40. Stanley KL, Weaver JE. Pharmacologic management of pain and inflammation in athletes. Clin Sports Med. 1998 Apr. 17(2):375-92. [Medline].

  41. McCarthy D. Nonsteroidal anti-inflammatory drug-related gastrointestinal toxicity: definitions and epidemiology. Am J Med. 1998 Nov 2. 105(5A):3S-9S. [Medline].

  42. Theodore GH, Buch M, Amendola A, et al. Extracorporeal shock wave therapy for the treatment of plantar fasciitis. Foot Ankle Int. 2004 May. 25(5):290-7. [Medline].

  43. Mehra A, Zaman T, Jenkin AI. The use of a mobile lithotripter in the treatment of tennis elbow and plantar fasciitis. Surgeon. 2003 Oct. 1(5):290-2. [Medline].

  44. Crawford F, Atkins D, Young P, Edwards J. Steroid injection for heel pain: evidence of short-term effectiveness. A randomized controlled trial. Rheumatology (Oxford). 1999 Oct. 38(10):974-7. [Medline].

  45. Pfenninger JL. Joint and soft tissue aspiration and injection. Pfenninger JL, Fowler GC, eds. Procedures for Primary Care Physicians. St. Louis, Mo: Mosby-Year Book; 1994. 1036-54.

  46. Yucel I, Yazici B, Degirmenci E, Erdogmus B, Dogan S. Comparison of ultrasound-, palpation-, and scintigraphy-guided steroid injections in the treatment of plantar fasciitis. Arch Orthop Trauma Surg. 2009 May. 129(5):695-701. [Medline].

  47. McMillan AM, Landorf KB, Gilheany MF, Bird AR, Morrow AD, Menz HB. Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial. BMJ. 2012 May 22. 344:e3260. [Medline].

  48. Chen CM, Chen JS, Tsai WC, Hsu HC, Chen KH, Lin CH. Effectiveness of device-assisted ultrasound-guided steroid injection for treating plantar fasciitis. Am J Phys Med Rehabil. 2013 Jul. 92(7):597-605. [Medline].

  49. Ball EM, McKeeman HM, Patterson C, Burns J, Yau WH, Moore OA, et al. Steroid injection for inferior heel pain: a randomised controlled trial. Ann Rheum Dis. 2013 Jun. 72(6):996-1002. [Medline].

  50. Ball EM, McKeeman HM, Patterson C, et al. Steroid injection for inferior heel pain: a randomised controlled trial. Ann Rheum Dis. 2013 Jun. 72(6):996-1002. [Medline].

  51. Kane D, Greaney T, Bresnihan B, Gibney R, FitzGerald O. Ultrasound guided injection of recalcitrant plantar fasciitis. Ann Rheum Dis. 1998 Jun. 57(6):383-4. [Medline]. [Full Text].

  52. Porter MD, Shadbolt B. Intralesional corticosteroid injection versus extracorporeal shock wave therapy for plantar fasciopathy. Clin J Sport Med. 2005 May. 15(3):119-24. [Medline].

  53. Govindarajan R, Bakalova T, Doss NW, Splain SH, Michael R, Abadir AR. Posterior tibial nerve block in the therapeutic management of painful calcaneal spur (plantar fasciitis): a preliminary experience. Can J Anaesth. 2003 Oct. 50(8):862-3. [Medline]. [Full Text].

  54. Tsai WC, Wang CL, Tang FT, et al. Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection. Arch Phys Med Rehabil. 2000 Oct. 81(10):1416-21. [Medline].

  55. Babcock MS, Foster L, Pasquina P, Jabbari B. Treatment of pain attributed to plantar fasciitis with botulinum toxin a: a short-term, randomized, placebo-controlled, double-blind study. Am J Phys Med Rehabil. 2005 Sep. 84(9):649-54. [Medline].

  56. Huang YC, Wei SH, Wang HK, Lieu FK. Ultrasonographic guided botulinum toxin type A treatment for plantar fasciitis: an outcome-based investigation for treating pain and gait changes. J Rehabil Med. 2010 Feb. 42(2):136-40. [Medline].

  57. Elizondo-Rodriguez J, Araujo-Lopez Y, Moreno-Gonzalez JA, Cardenas-Estrada E, Mendoza-Lemus O, Acosta-Olivo C. A comparison of botulinum toxin a and intralesional steroids for the treatment of plantar fasciitis: a randomized, double-blinded study. Foot Ankle Int. 2013 Jan. 34(1):8-14. [Medline].

  58. Martin RP. Autologous blood injection for plantar fasciitis: a retrospective study. Paper presented at: Annual meeting of the American Medical Society for Sports Medicine; April 16-20, 2005; Austin, Texas. Clin J Sport Med. 2005 Sept. 15:387-8.

  59. Kiter E, Celikbas E, Akkaya S, Demirkan F, Kiliç BA. Comparison of injection modalities in the treatment of plantar heel pain: a randomized controlled trial. J Am Podiatr Med Assoc. 2006 Jul-Aug. 96(4):293-6. [Medline].

  60. Lee TG, Ahmad TS. Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis. A prospective, randomized, controlled trial. Foot Ankle Int. 2007 Sep. 28(9):984-90. [Medline].

  61. Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am. 1999 Feb. 81(2):259-78. [Medline].

  62. Kumar V, Millar T, Murphy PN, Clough T. The treatment of intractable plantar fasciitis with platelet-rich plasma injection. Foot (Edinb). 2013 Jun-Sep. 23(2-3):74-7. [Medline].

  63. van Egmond JC, Breugem SJ, Driessen M, Bruijn DJ. Platelet-Rich-Plasma injection seems to be effective in treatment of plantar fasciitis: a case series. Acta Orthop Belgica. 2015 Jun. 81:315-20. [Medline].

  64. Lee TG, Ahmad TS. Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis. A prospective, randomized, controlled trial. Foot Ankle Int. 2007 Sep. 28(9):984-90. [Medline].

  65. Kiter E, Celikbas E, Akkaya S, Demirkan F, Kiliç BA. Comparison of injection modalities in the treatment of plantar heel pain: a randomized controlled trial. J Am Podiatr Med Assoc. 2006 Jul-Aug. 96(4):293-6. [Medline].

  66. Hanselman AE, Tidwell JE, Santrock RD. Cryopreserved human amniotic membrane injection for plantar fasciitis: a randomized, controlled, double-blind pilot study. Foot Ankle Int. 2015 Feb. 36:151-8. [Medline].

  67. Aqil A, Siddiqui MR, Solan M, Redfern DJ, Gulati V, Cobb JP. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs. Clin Orthop Relat Res. 2013 Nov. 471(11):3645-52. [Medline]. [Full Text].

  68. Dizon JN, Gonzalez-Suarez C, Zamora MT, Gambito ED. Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis: a meta-analysis. Am J Phys Med Rehabil. 2013 Jul. 92(7):606-20. [Medline].

  69. Rompe JD, Decking J, Schoellner C, Nafe B. Shock wave application for chronic plantar fasciitis in running athletes. A prospective, randomized, placebo-controlled trial. Am J Sports Med. 2003 Mar-Apr. 31(2):268-75. [Medline].

  70. Hyer CF, Vancourt R, Block A. Evaluation of ultrasound-guided extracorporeal shock wave therapy (ESWT) in the treatment of chronic plantar fasciitis. J Foot Ankle Surg. 2005 Mar-Apr. 44(2):137-43. [Medline].

  71. Alvarez R., Cross, G.L., Levitt, R., Gould, et al. Chronic proximal Plantar Fasciitis Treatment Results with the Ossatron ESW System. FDA Investigational Study P990086, approval 10-12-2000. [Full Text].

  72. Chuckpaiwong B, Berkson EM, Theodore GH. Extracorporeal shock wave for chronic proximal plantar fasciitis: 225 patients with results and outcome predictors. J Foot Ankle Surg. 2009 Mar-Apr. 48(2):148-55. [Medline].

  73. Gollwitzer H, Saxena A, DiDomenico LA, Galli L, Bouche RT, Caminear DS, et al. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. J Bone Joint Surg - Am. 2015 May. 97:701-8. [Medline].

  74. Ogden JA, Cross GL, Williams SS. Bilateral chronic proximal plantar fasciopathy: treatment with electrohydraulic orthotripsy. Foot Ankle Int. 2004 May. 25(5):298-302. [Medline].

  75. Ogden JA, Alvarez RG, Levitt RL, Johnson JE, Marlow ME. Electrohydraulic high-energy shock-wave treatment for chronic plantar fasciitis. J Bone Joint Surg Am. 2004 Oct. 86-A(10):2216-28. [Medline].

  76. Speed CA, Nichols D, Wies J, et al. Extracorporeal shock wave therapy for plantar fasciitis. A double blind randomised controlled trial. J Orthop Res. 2003 Sep. 21(5):937-40. [Medline].

  77. Hammer DS, Adam F, Kreutz A, Kohn D, Seil R. Extracorporeal shock wave therapy (ESWT) in patients with chronic proximal plantar fasciitis: a 2-year follow-up. Foot Ankle Int. 2003 Nov. 24(11):823-8. [Medline].

  78. Stratton M, McPoil TG, Cornwall MW, Patrick K. Use of low-frequency electrical stimulation for the treatment of plantar fasciitis. J Am Podiatr Med Assoc. 2009 Nov-Dec. 99(6):481-8. [Medline].

  79. Ibrahim MI, Donatelli RA, Schmitz C, Hellman MA, Buxbaum F. Chronic plantar fasciitis treated with two sessions of radial extracorporeal shock wave therapy. Foot Ankle Int. 2010 May. 31(5):391-7. [Medline].

  80. Mariotto S, de Prati AC, Cavalieri E, Amelio E, Marlinghaus E, Suzuki H. Extracorporeal shock wave therapy in inflammatory diseases: molecular mechanism that triggers anti-inflammatory action. Curr Med Chem. 2009. 16(19):2366-2372.

  81. Lohrer H, Nauck T, Dorn-Lange NV, Schöll J, Vester JC. Comparison of radial versus focused extracorporeal shock waves in plantar fasciitis using functional measures. Foot Ankle Int. 2010 Jan. 31(1):1-9. [Medline].

  82. Greve JM, Grecco MV, Santos-Silva PR. Comparison of radial shockwaves and conventional physiotherapy for treating plantar fasciitis. Clinics (Sao Paulo). 2009. 64(2):97-103. [Medline]. [Full Text].

  83. Zhiyun L, Tao J, Zengwu S. Meta-analysis of high-energy extracorporeal shock wave therapy in recalcitrant plantar fasciitis. Swiss Med Wkly. 2013 Jul 7. 143:w13825. [Medline].

  84. Aqil A, Siddiqui MR, Solan M, Redfern DJ, Gulati V, Cobb JP. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs. Clin Orthop Relat Res. 2013 Nov. 471(11):3645-52. [Medline]. [Full Text].

  85. Dizon JN, Gonzalez-Suarez C, Zamora MT, Gambito ED. Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis: a meta-analysis. Am J Phys Med Rehabil. 2013 Jul. 92(7):606-20. [Medline].

  86. Dogramaci Y, Kalaci A, Emir A, Yanat AN, Gökçe A. Intracorporeal pneumatic shock application for the treatment of chronic plantar fasciitis: a randomized, double blind prospective clinical trial. Arch Orthop Trauma Surg. Aug 2009.

  87. Martin JE, Hosch JC, Goforth WP, Murff RT, Lynch DM, Odom RD. Mechanical treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc. 2001 Feb. 91(2):55-62. [Medline].

  88. Batt ME, Tanji JL, Skattum N. Plantar fasciitis: a prospective randomized clinical trial of the tension night splint. Clin J Sport Med. 1996 Jul. 6(3):158-62. [Medline].

  89. Wapner KL, Sharkey PF. The use of night splints for treatment of recalcitrant plantar fasciitis. Foot Ankle. 1991 Dec. 12(3):135-7. [Medline].

  90. Powell M, Post WR, Keener J, Wearden S. Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. Foot Ankle Int. 1998 Jan. 19(1):10-8. [Medline].

  91. Mizel MS, Marymont JV, Trepman E. Treatment of plantar fasciitis with a night splint and shoe modification consisting of a steel shank and anterior rocker bottom. Foot Ankle Int. 1996 Dec. 17(12):732-5. [Medline].

  92. Berlet GC, Anderson RB, Davis H, Kiebzak GM. A prospective trial of night splinting in the treatment of recalcitrant plantar fasciitis: the Ankle Dorsiflexion Dynasplint. Orthopedics. 2002 Nov. 25(11):1273-5. [Medline].

  93. Probe RA, Baca M, Adams R, Preece C. Night splint treatment for plantar fasciitis. A prospective randomized study. Clin Orthop Relat Res. 1999 Nov. 190-5. [Medline].

  94. Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med. 2006 Jun 26. 166(12):1305-10. [Medline].

  95. Caselli MA, Clark N, Lazarus S, Velez Z, Venegas L. Evaluation of magnetic foil and PPT Insoles in the treatment of heel pain. J Am Podiatr Med Assoc. 1997 Jan. 87(1):11-6. [Medline].

  96. Kogler GF, Solomonidis SE, Paul JP. Biomechanics of longitudinal arch support mechanisms in foot orthoses and their effect on plantar aponeurosis strain. Clin Biomech (Bristol, Avon). 1996 Jul. 11(5):243-252. [Medline].

  97. Kogler GF, Solomonidis SE, Paul JP. In vitro method for quantifying the effectiveness of the longitudinal arch support mechanism of a foot orthosis. Clin Biomech (Bristol, Avon). 1995 Jul. 10(5):245-252. [Medline].

  98. Lee SY, McKeon P, Hertel J. Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis. Phys Ther Sport. 2009 Feb. 10(1):12-8. [Medline].

  99. Baldassin V, Gomes CR, Beraldo PS. Effectiveness of prefabricated and customized foot orthoses made from low-cost foam for noncomplicated plantar fasciitis: a randomized controlled trial. Arch Phys Med Rehabil. April 2009. 90(4):701-706.

  100. Walther M, Kratschmer B, Verschl J, Volkering C, Altenberger S, Kriegelstein S, et al. Effect of different orthotic concepts as first line treatment of plantar fasciitis. Foot Ankle Surg. 2013 Jun. 19(2):103-7. [Medline].

  101. Lynch DM, Goforth WP, Martin JE, et al. Conservative treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc. 1998 Aug. 88(8):375-80. [Medline].

  102. van de Water AT, Speksnijder CM. Efficacy of taping for the treatment of plantar fasciosis: a systematic review of controlled trials. J Am Podiatr Med Assoc. 2010 Jan-Feb. 100(1):41-51. [Medline].

  103. Chia KK, Suresh S, Kuah A, Ong JL, Phua JM, Seah AL. Comparative trial of the foot pressure patterns between corrective orthotics,formthotics, bone spur pads and flat insoles in patients with chronic plantar fasciitis. Ann Acad Med Singapore. 2009 Oct. 38(10):869-75. [Medline].

  104. Morris D, Jones D, Ryan H, Ryan CG. The clinical effects of Kinesio® Tex taping: A systematic review. Physiother Theory Pract. 2013 May. 29(4):259-70. [Medline].

  105. Kwong PK, Kay D, Voner RT, White MW. Plantar fasciitis. Mechanics and pathomechanics of treatment. Clin Sports Med. 1988 Jan. 7(1):119-26. [Medline].

  106. Gudeman SD, Eisele SA, Heidt RS Jr, Colosimo AJ, Stroupe AL. Treatment of plantar fasciitis by iontophoresis of 0.4% dexamethasone. A randomized, double-blind, placebo-controlled study. Am J Sports Med. 1997 May-Jun. 25(3):312-6. [Medline].

  107. Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord. 2007 Apr 19. 8:36. [Medline]. [Full Text].

  108. DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. 2003 Jul. 85-A(7):1270-7. [Medline].

  109. Miyamoto W, Takao M, Uchio Y. Calcaneal osteotomy for the treatment of plantar fasciitis. Arch Orthop Trauma Surg. 2010 Feb. 130(2):151-4. [Medline].

  110. Tomczak RL, Haverstock BD. A retrospective comparison of endoscopic plantar fasciotomy to open plantar fasciotomy with heel spur resection for chronic plantar fasciitis/heel spur syndrome. J Foot Ankle Surg. 1995 May-Jun. 34(3):305-11. [Medline].

  111. Kinley S, Frascone S, Calderone D, Wertheimer SJ, Squire MA, Wiseman FA. Endoscopic plantar fasciotomy versus traditional open heel spur surgery: a prospective study. J Foot Ankle Surg. 1993. 32:595-603.

  112. Malay DS, Pressman MM, Assili A, et al. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial. J Foot Ankle Surg. 2006 Jul-Aug. 45(4):196-210. [Medline].

  113. Daly PJ, Kitaoka HB, Chao EY. Plantar fasciotomy for intractable plantar fasciitis: clinical results and biomechanical evaluation. Foot Ankle. 1992 May. 13(4):188-95. [Medline].

  114. Leach RE, Seavey MS, Salter DK. Results of surgery in athletes with plantar fasciitis. Foot Ankle. 1986 Dec. 7(3):156-61. [Medline].

  115. Benton-Weil W, Borrelli AH, Weil LS Jr, Weil LS Sr. Percutaneous plantar fasciotomy: a minimally invasive procedure for recalcitrant plantar fasciitis. J Foot Ankle Surg. 1998 Jul-Aug. 37(4):269-72. [Medline].

  116. Sollitto RJ, Plotkin EL, Klein PG, Mullin P. Early clinical results of the use of radiofrequency lesioning in the treatment of plantar fasciitis. J Foot Ankle Surg. 1997 May-Jun. 36(3):215-9; discussion 256. [Medline].

  117. Boyle RA, Slater GL. Endoscopic plantar fascia release: a case series. Foot Ankle Int. 2003 Feb. 24(2):176-9. [Medline].

  118. Conflitti JM, Tarquinio TA. Operative outcome of partial plantar fasciectomy and neurolysis to the nerve of the abductor digiti minimi muscle for recalcitrant plantar fasciitis. Foot Ankle Int. 2004 Jul. 25(7):482-7. [Medline].

  119. Jerosch J, Schunck J, Liebsch D, Filler T. Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (E FRPF). Knee Surg Sports Traumatol Arthrosc. 2004 Sep. 12(5):471-7. [Medline].

  120. Bazaz R, Ferkel RD. Results of endoscopic plantar fascia release. Foot Ankle Int. 2007 May. 28(5):549-56. [Medline].

  121. Fallat LM, Cox JT, Chahal R, Morrison P, Kish J. A retrospective comparison of percutaneous plantar fasciotomy and open plantar fasciotomy with heel spur resection. J Foot Ankle Surg. 2013 May-Jun. 52(3):288-90. [Medline].

  122. Allen BH, Fallat LM, Schwartz SM. Cryosurgery: an innovative technique for the treatment of plantar fasciitis. J Foot Ankle Surg. 2007 Mar-Apr. 46(2):75-9. [Medline].

  123. Cavazos GJ, Khan KH, D'Antoni AV, Harkless LB, Lopez D. Cryosurgery for the treatment of heel pain. Foot Ankle Int. 2009 Jun. 30(6):500-5. [Medline].

  124. Sorensen MD, Hyer CF. Bi-Polar Radiofrequency Microdebridement in the Treatment of Chronic Recalcitrant Plantar Fasciitis. Presented at the American College of Foot & Ankle Surgeons Annual Meeting, 2009, Washington, D.C;

  125. Liden B, Simmons M, Landsman AS. A retrospective analysis of 22 patients treated with percutaneous radiofrequency nerve ablation for prolonged moderate to severe heel pain associated with plantar fasciitis. J Foot Ankle Surg. 2009 Nov-Dec. 48(6):642-7. [Medline].

  126. Chew KT, Leong D, Lin CY, Lim KK, Tan B. Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomized trial. PM R. 2013 Dec. 5(12):1035-43. [Medline].

  127. Peerbooms JC, van Laar W, Faber F, Schuller HM, van der Hoeven H, Gosens T. Use of platelet rich plasma to treat plantar fasciitis: design of a multi centre randomized controlled trial. BMC Musculoskelet Disord. 2010 Apr 14. 11:69. [Medline]. [Full Text].

 
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Weight-bearing windlass test.
Calf stretch.
Towel curl.
Toe taps.
Night splint.
Low-dye taping method. This technique provides support for plantar fascia and helps reduce excessive pronation.
Example of arch support with cushioned heel. These are available in three-quarter or full lengths to fit in shoe.
Example of night splint. These are intended to prevent shortening of Achilles tendon and plantar fascia at night.
Orthosis
Night splint, designed to prevent shortening of Achilles tendon and plantar fascia at night.
Plantar fascia stretching exercise.
 
 
 
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