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Plantar fasciitis is one of the most frequent reason for consultation in the podiatric field(1). This inflammation of the plantar fascia, fibrous band that runs along the sole of the foot, causes persistent pain. Very often, the presence of a heel spur is considered as responsible for these heel pain.
Indeed, there is a great confusion surrounding these two closely related conditions. When the plantar fascia is subject to excessive tension, it triggers the formation of a heel spur. This overuse may cause microtraumas on the fascia and lead to its inflammation. The spur precisely develops where the plantar fascia attaches to the heel bone (calcaneus).
Finally, it’s not the heel spur that causes pain but rather the inflammation of the plantar fascia. Since they have similar causes and symptoms, their treatments are also very close. EPITACT® reports the 6 different treatments of plantar fasciitis.
Plantar fasciitis: treatment
The treatment of plantar fasciitis mainly focuses on conservative options. EPITACT® has summarised the different steps in the treatment of plantar fasciitis.
• Plantar fasciitis: treatment No. 1: Fighting against aggravating factors
The treatment of plantar fasciitis, no matter the stage and intensity of pain, begins by fighting against the causes and factors that aggravate the development of inflammation.
To address static disorders (hyperpronated, hollow or flat feet), there are different possibilities: wearing heel lifts or orthoses. Orthoses are usually recommended for static disorders, but heel lifts immediately reduce the stress on the fascia(2).
To prevent or relieve pain, EPITACT® suggests you the heel lifts* partly made from silicone. They cushion the shocks under the heel and soothe pain while slightly lifting the heel. Adhesive and ultra-thin, they ensure a good hold in the shoe and provide comfort during each step.
In order to limit the repetition of microtraumas, the treatment consists in resting the foot. It entails limiting prolonged standing positions and changing the activities that favour the condition, especially for sportspersons. Indeed, runners are the most affected by plantar fasciitis. According to the pain, it is recommended to adapt the frequency, intensity and duration of the activity. In acute stages, it is important to favour sports like swimming or cycling for example. To relieve the plantar fascia, 2 weeks of rest are necessary(3). It reduces inflammation and so pain.
Also, wearing appropriate shoes with ergonomic sole, relatively thick to cushion shocks and pressures on the plantar fascia, is efficient. Also, choose shoes that fit the curves of your foot, especially in the heel. In this way, avoid flat shoes that poorly support the foot, whose sole thickness or materials do not allow effective shock absorption.
Lastly, for overweight people, a balanced diet will help lose weight to relieve the plantar fascia.
• Plantar fasciitis: treatment No. 2: Drug treatments
Additionally, the treatment of plantar fasciitis can include analgesics and non-steroidal anti-inflammatory drugs(4). These are symptomatic treatments with temporary effects on pain and inflammation.
• Plantar fasciitis: treatment No. 3: Stretching exercises
Doing exercises, either with a physiotherapist or at home, aim to stretch the plantar fascia. They can be completed by massages of the sole of the foot. EPITACT® has gathered for you some simple exercises to improve the symptoms related to this inflammation under the foot.
It is also possible to relieve pain by applying something cold on the painful area, especially in the beginning of the condition. Take a frozen water bottle and make it roll on the bottom of your foot, 10 to 20 minutes, 2 to 4 times per day(3).
Fortunately, if the combination of the treatments of plantar fasciitis listed above is not sufficient after 3 months, other options exist.
• Plantar fasciitis: treatment No. 4: Corticosteroid injections
Corticosteroid injections at the insertion point of the plantar fascia on the calcaneus can reduce inflammation. Only 3 successive injections are possible, with a minimal interval of one week between each of them(5).
However, it has been proved that this step of treatment has only short-term effectiveness to relieve inflammation. Injections can possibly be used as a first line approach if pain is unbearable or if the condition is too severe.
• Plantar fasciitis: treatment No. 4: Shock waves
If the previous treatments have been insufficient, the effects of shock waves are positive on plantar fasciitis symptoms(6). The main objectives of this non-invasive treatment are to destroy the damaged fibres and to boost the production of collagen. Indeed, the plantar fascia is a fibrous membrane mainly composed of collagen.
• Plantar fasciitis: treatment No. 5: Surgery
Surgery is only considered if the patient has not responded well to the previous treatments. It is rarely performed since 90 to 96% of cases of plantar fasciitis are cured with conservative treatments like those listed above(5). Also, in some situations, surgery causes irremediably collapse of the foot arch because of the fascia incision.
For more information about plantar fasciitis surgery, please refer to our article here.
You probably understood that the treatment of plantar fasciitis is mainly conservative and preventive. Fighting against its risk factors can reduce pain and inflammation, but can also avoid recurrence! However, each person is unique and may respond differently to the treatments prescribed to cure plantar fasciitis.
*This product is a class I medical device that bears the CE marking under this regulation. Carefully read the instructions before use. Manufacturer: Millet Innovation. 01/2022
For more details about this general and simplified approach, here are further sources:
(1)Gonzalez-Martin C, Pertega-Diaz S, Seijo-Bestilleiro R, Garcia-Rodriguez MT. Satisfaction with Orthopedic Treatments [Internet]. Prosthetics and Orthotics. IntechOpen; 2021 [cité 8 déc 2021]. Disponible sur: https://www.intechopen.com/chapters/76832
(2)Frey C, Zamora J. The Effects of Obesity on Orthopaedic Foot and Ankle Pathology. Foot Ankle Int. sept 2007;28(9):996‑9.
(2)Drake M, Bittenbender C, Boyles RE. The Short-Term Effects of Treating Plantar Fasciitis With a Temporary Custom Foot Orthosis and Stretching. J Orthop Sports Phys Ther. 1 avr 2011;41(4):221‑31. 2014;10:241 2.
(3)Hasegawa M, Urits I, Orhurhu V, Orhurhu MS, Brinkman J, Giacomazzi S, et al. Current Concepts of Minimally Invasive Treatment Options for Plantar Fasciitis: a Comprehensive Review. Curr Pain Headache Rep. sept 2020;24(9):55.
(4)Luffy L, Grosel J, Thomas R, So E. Plantar fasciitis: A review of treatments. Journal of the American Academy of Physician Assistants. janv 2018;31(1):20‑4.
(5)Kahn M-F, Bardin T, Dieudé P, Lioté F, Meyer O, Orcel P, et al. L’actualité rhumatologique 2013. Elsevier Health Sciences; 2013.
(6)Aqil A, Siddiqui MRS, Solan M, Redfern DJ, Gulati V, Cobb JP. Extracorporeal Shock Wave Therapy Is Effective In Treating Chronic Plantar Fasciitis: A Meta-analysis of RCTs. Clinical Orthopaedics & Related Research. nov 2013;471(11):3645‑52.