Treatment includes measures to control pain and inflammation, minimize overload forces, and to promote tissue healing. Proper shoe wear is essential. Anti-inflammatories are useful (as long as there is no reason not to take them ie allergies to anti-inflammatories or aspirin, pregnancy, or if you have a history of stomach ulcers, or kidney or liver disease). In chronic or especially painful cases, I may prescribe a short course of oral steroids first. Stretching of the calf muscles and plantar fascia is performed. Remember to perform the calf stretch with the knee bent as well as straight as these 2 positions emphasize different muscles. The fascia is stretched by extending the toes against a wall or the floor. Strengthening the foot and ankle muscles is important. Useful exercises include towel scrunches, picking up marbles, and “short foot” exercises, where the runner stands on one foot while maintaining the arch of the foot. Several devices are marketed to assist with plantar fasciitis. I have found good success recommending the counterforce arch brace designed by my sportsmedicine mentor, Robert Nirschl, MD, MS and available through running shops or direct from Medical Sports, Inc. Other useful devices include gel heel cushions and over the counter orthotics. If symptoms persist beyond 6 weeks of this level of treatment, formal physical therapy can be useful to apply modalities such as iontophoresis (delivering anti-inflammatory medication with an electric stimulator) or ultrasound, manual therapy to ensure proper joint motion, and expanding one’s exercise regimen. A night splint designed to apply a light stretch while sleeping can be useful. In select instances, custom orthotics may be indicated to control specific biomechanical contributors. In longterm or particularly painful cases, steroid injections can be applied to help facilitate the rehab process. Since steroid serves only to control inflammation, injections should not be viewed as treatment in and of themselves. Additionally, since steroids can potentially weaken the local tissues, I recommend refraining from running for 10-14 days after this type of injection.
The obesity epidemic in the United States is widely recognized as contributing to the rise in incidence of this condition by mechanically stressing the plantar fascia. In addition, some occupations may increase a person’s risk for plantar fasciitis, such as those that require squatting, stooping, standing, or walking for long periods or those that require climbing ladders or poles. This common condition is also rampant among athletes. Those who practice sports medicine or who treat active-duty military often are swamped with patients complaining of plantar fasciitis.