Plantar Fasciitis: Initial Treatment Options

This condition is typically self-limiting, meaning that it will often go away on its own; however, treatment can speed up recovery time and prevent the condition from getting worse.

See Is Heel Pain Caused by Heel Spurs or Plantar Fasciitis?

Doctors usually recommend taking a multi-pronged approach to treating plantar fasciitis. For example, a patient who jogs may be initially advised to cut back on weekly mileage, change running shoes, and commit to a new stretching routine.

Non-medical Treatments

Initial treatments for plantar fasciitis do not involve injections or surgery. Patients can initiate some treatments, such as rest and stretching, on their own, while others should be done under a doctor’s supervision.

Rest. Patients are advised to cut back on jogging or other activities that keep them on their feet for an extended period of time. This decrease in activity usually only needs to last a week or two for plantar fascia to heal.

Better footwear.Comfortable shoes with soft soles and arch supports will place less strain on the plantar fascia. For some athletes, just changing running shoes can significantly ease plantar fascia pain.

Taping. A physical therapist can employ a number of different taping techniques to support the plantar fascia, giving it a chance to heal.

Shoe inserts. Some shoes can be fitted with inserts. One example is an orthotic, which spans the length of the shoe. It can provide support and put less strain on the plantar fascia. Another option is a heel cup. This insert is designed to support and cushion the heel.

Stretching. Plantar fasciitis is associated with less flexibility in the ankle, Achilles tendon, and calf muscles. Gentle stretching to improve flexibility can make the biomechanics of standing, walking, and jogging less stressful for the plantar fascia.

See Plantar Fasciitis: A Treatment Guide

Commonly recommended stretches include:

• Sit in a chair and with feet flat on the ground, then place a tennis ball under the affected foot. Using gentle pressure, roll the tennis ball back and forth under the foot.
• Stand 18 inches away from a wall with feet about 6 inches apart and place hands against the wall, at shoulder height. Without moving feet, lean into the wall, flexing the foot and stretching the Achilles tendon and calf muscles
• Sit on the floor with legs straight in front. Wrap a belt or exercise strap around the ball of the foot, and gently pull on the strap, forcing the foot to flex.

Stretches like these last two, in which the top of the foot and toes move toward the shin, are called dorsiflexion stretches

Icing. Applying a cold-pack or bag of ice to bottom of the foot may provide pain relief from plantar fasciitis. Relief can also be found by rolling the bottom of the foot on a frozen plastic water bottle.

See The P.R.I.C.E. Protocol Principles

Shorter running strides. For runners, increasing the number of steps per mile—using a shorter stride but increasing cadence to maintain speed—may reduce the stress on the plantar fascia even though there will be more steps per minute.¹Wellenkotter J, Kernozek TW, Meardon S, Suchomel T. The effects of running cadence manipulation on plantar loading in healthy runners. Int J Sports Med. 2014;35(9):779-84.

Weight loss. Extra weight puts an increased strain on the plantar fascia tissue. Shedding excess pounds will lighten the load on the body’s musculoskeletal system, including the plantar fascia.

Night splints. These plastic casts are worn at night and keep the ankle flexed at 90 degrees. This prevents the plantar fascia from resting in a contracted position. (Understandably, many people find these splints difficult to sleep in.)

Massage. While it is not considered standard treatment, deep myofascial massage may promote blood flow and healing.

Manipulation. While not all experts agree, some think the use of manual manipulation/mobilization (by a chiropractor or other qualified health professional) along with exercise is an effective way to treat plantar fasciitis.²Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18:3.^,3Clar C, Tsertsvadze A, Court R, Hundt GL, Clarke A, Sutcliffe P. Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report. Chiropr Man Therap. 2014;22(1):12.

People with persistent, moderate to severe cases of plantar fasciitis, may use these non-medical treatments in conjunction with medications, injections, or surgical treatments.

Medications

Certain medications can ease pain and decrease inflammation from plantar fasciitis. Medications are not a cure for plantar fasciitis and should be used in conjunction with other treatments..

NSAIDs. Non-steroidal anti-inflammatory drugs are used to reduce swelling and inflammation, and are recommended for patients experiencing moderate to severe pain. NSAIDs include aspirin (e.g. Bayer), ibuprofen (e.g. Advil), naproxen (e.g. Aleve), and cox-2 inhibitors.

Iontophoresis. This treatment uses a mild electrical current to administer an anti-inflammatory medicine (e.g. dexamethasone) through healthy skin to the sore area.¹Wellenkotter J, Kernozek TW, Meardon S, Suchomel T. The effects of running cadence manipulation on plantar loading in healthy runners. Int J Sports Med. 2014;35(9):779-84. Iontophoresis may be recommended to patients with plantar fasciitis who can't tolerate injections or want to avoid injections.

If non-medical treatments and medications do not provide relief from plantar fasciitis, patients may consider injections.