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Sunday, January 10, 2021

Plantar Fasciitis: Top 10 Treatments

Plantar Fasciitis


The top 10 common treatments for plantar fasciitis:


1. Plantar Fascial wall stretch for 30 seconds 5-10x/day

2. Rolling ice massage 2-3x/day for 5 minutes

3. No negative heel stretches

4. Avoid barefoot walking (something like dansko sandal at home)

5. OTC or custom orthotic devices to transfer weight into the  arch (you must feel that the   heel is protected and weight is in the arch)

6. Physical therapy or acupuncture (2x/week for 4 weeks and then re-evaluate)

7. Posterior sleeping splints when morning soreness over 5 minutes (these can be used at any time as rest splints when you are going to sit 30 minutes or more)

8. Low dye/arch taping daily initially and then with strenuous activity (Try Quick Tape from for tape that works and lasts up to a week)

9. Activity modification to avoid “bad pain”

10. Calf stretches (straight and bent knee) 2x/day

This can be such a stubborn problem that it is easy to get very frustrated. Very few people need surgery (even if you have a heel spur noted on x ray) for this since there are so many options for treatment. I once did a thorough review of the literature and found easily 72 different treatment options that made sense. These treatment options are so numerous that we are normally limited only by our time and imaginations to develop a successful treatment plan. Each week (or every 2 week interval) there should be improvement once active treatment begins. If improvement plateaus, make a change. Analyzing what is working and what is not working should be part of the process.

When treating plantar fasciitis we typically deal constantly with the 3 areas of treatment---anti-inflammatory, stretching or flexibility, and mechanical support (transference of pressure from the painful areas to non-painful areas or limiting the pull of the fascia by less pronation, less big toe joint dorsiflexion, or less impact stress to the arch). Most cases of plantar fasciitis need simple solutions like daily icing (anti-inflammatory), plantar fascial and achilles stretching 3 times daily (flexibility), and arch support (either custom orthotics or store-bought arch supports). Some more stubborn cases of plantar fasciitis need the above along with physical therapy to improve flexibility and anti-inflammatory measures, custom-made orthotics if not already manufactured, night splints to gentle stretch out the plantar fascia, and many other options. Cortisone shots are actually never given for plantar fasciitis, since you do not want to inject and weaken the plantar fascia. Cortisone is given to the area under the heel (typically a bursitis which develops secondary to the chronic inflammation) and away from the fascial bone attachment. 

In resistant cases, 3 months in a removable cast can help calm down the inflammation and strengthen the plantar fascia which may have some micro tearing not well visualized on MRI or felt by the patient. The moral of the story with plantar fasciitis is never give up. Keep trying to find the right combination of anti-inflammatory, flexibility, and mechanical support. Also remember that 25 to 30% of all cases I see for plantar fasciitis for a second opinion, have something else. Neuritis, bursitis, stress fractures, plantar fascial tears all head the list in the differential diagnosis that may need completely other forms of treatment. 

The above was an excerpt from my book “Secrets to Keep Moving”. 

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.