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Treatment of plantar fasciitis

by — Last updated: 2017-05-29 in Musculoskeletal Issues

Table of Contents

Plantar fasciitis is a very specific condition and the most common cause of heel pain. It represents the inflammation of the plantar fascia. The inflammation in the tissue is the result of some type of injury to the plantar fascia.

There are several types of treatment which proved beneficial in treating plantar fasciitis:

  • Conservative treatment
  • Exercises
  • Anti-inflammatory agents
  • Surgical procedures

Conservative treatment

Night splints have shown to be very helpful to the patients. Doctor may recommend wearing a splint fitted to patient’s calf and foot while he or she is sleeping. This holds the plantar fascia and Achilles tendon in a lengthened position overnight so that they can be stretched more effectively.

For a long time now doctors have been prescribing these custom-fitted shoe inserts called orthotics.  They are molded to fit each patient’s feet, to help distribute the pressure on the feet more evenly. Custom orthotics are usually made by taking a plaster cast or an impression of the individual's foot and then constructing an insert specifically designed to control biomechanical risk factors.

Exercises

A physical therapist can devise a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize ankle and heel. A therapist may also teach the patient to apply athletic taping to support the bottom of the foot.

  1. Stretching and strengthening programs play an important role in the treatment of plantar fasciitis and can correct functional risk factors such as tightness of the gastrocsoleus complex and weakness of the intrinsic foot muscles.
  2. Other effective techniques include use of a slant board (Figure 3) or placing a two-inch 3  four-inch piece of wood.

Strengthening programs should focus on intrinsic muscles of the foot.

Exercises used include towel curls and toe taps.

  • Exercises such as picking up marbles and coins with the toes are also useful.

Anti-inflammatory agents

Anti-inflammatory agents used in the treatment of plantar fasciitis include:

  • Ice - it is applied in the treatment of plantar fasciitis by ice massage, ice bath or in an ice pack. To use an ice bath, a shallow pan is filled with water and ice, and the heel is allowed to soak for 10 to 15 minutes.
  • NSAIDs – They seem to cause an improvement in great majority of the patients. Advantages of NSAIDs are the acceptability of the use of an oral medication and the acceptance by medical insurance. Disadvantages of NSAIDs are many, including the risk of gastrointestinal bleeding, gastric pain and renal damage.
  • Iontophoresis - Iontophoresis is the use of electric impulses from a low-voltage galvanic current stimulation unit to drive topical corticosteroids into soft tissue structures.
  • Cortisone injections – They have the greatest benefit if administered early in the course of the disease. Steroids can be injected via plantar or medial approaches with or without the  ultrasound guidance.

Surgical procedure

In cases when the condition does not respond to any conservative treatment, surgical release of the plantar fascia may be considered. The operation is called plantar fasciotomy. It may be performed using open, endoscopic or radiofrequency techniques. What makes this operation good? Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. Of course, there are some potential risk factors and the most common include flattening of the longitudinal arch and heel hypoesthesia as well as the potential complications associated with rupture of the plantar fascia and complications related to anesthesia.