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Plantar Fasciitis Management Plan

July 1, 2016

 

Updated: June 2017


Stop any treatment that increases your pain and contact Inform Podiatry

 

 

Modify weight bearing activity

  • Reduce prolonged standing

  • Less running or walking

  • More swimming or cycling

 

Benefits: helpful

 

Side effects: none reported

Foot taping and padding [1] [2]

  • No need to keep dry in shower

  • Remove after 3-4 days

  • Remove if skin becomes itchy

 

Benefits: helpful

 

Side effects: common; allergy, 1 in 10 [2]

Calf stretches [1]

  • Begin after tape removed

  • Both feet in shoes off edge of step

  • 1-3 mins morning and night

 

Benefits: helpful

 

Side effects: none reported

Plantar arch stretch [1] [3] [8]

  • Begin after tape removed

  • Pull big toe and foot toward front of lower leg

  • Massage under arch from heel to toes for 3-5 mins daily (especially in the morning)

 

Benefits: helpful

 

Side effects: none reported

Heel padding [1]

  • 6mm or 3mm Poron heel padding

 

Benefits: helpful

 

Side effects: none reported

Footwear at home [5]

 

Benefits: helpful

 

Side effects: none reported

Ice [5]

  • Begin after tape removed

  • Use either a 600ml plastic bottle or gel ice pack

  • Use for 20 mins per hour

 

Benefits: helpful

 

Side effects: uncommon; ice burn

Massage balls

  • Begin after tape removed

  • Roll heel and plantar arch over ball for 3-5mins

 

Benefits: maybe helpful

 

Side effects: none reported

Anti-inflammatory medication [5]

  • Begin after tape removed (gel)

  • Use either tablets or gel

  • Ibuprofen (eg Nurofen) or diclofenac (eg Voltarin)

  • See your GP to discuss stronger anti-inflammatory medication requiring a script

 

Benefits: helpful

 

Side effects: common; gastritis with tablets, 7 in 10 [4]

  • Don’t use tablets or gel if asthmatic or history of heart problems

  • Don’t use tablets if history of stomach ulcers

  • Codeine is not recommended as there is no evidence it’s more effective but it increases side effects

Orthoses [1] [5]

  • Custom and prefab options

  • More likely to help if foot tapping and padding helped

  • Custom fit better to your feet and in your footwear and last longer than prefab

  • Prefab have a lower total cost but custom may have smaller gap cost

 

Benefits: helpful

 

Side effects: common; pain due to orthoses, 4 in 100 [6]

Night splint [1]

  • Many types available to purchase online or from Medical Accessories.

  • More likely to help if calf stretches or plantar arch stretch helped

 

Benefits: helpful

 

Side effects: none reported

Manual therapy [1] [3]

  • Joint mobilisation

  • Soft tissue mobilisation

  • Trigger point therapy [7]

 

Benefits: helpful

 

Side effects: common; slight soreness after treatment lasting 2 days after the first 2 sessions, 2 in 10 [7]

Plantar arch strength training [8]

  • Both feet heel raises with towel rolled up under toes

  • Progress to single foot heel raise

  • 12 reps, 1-3 sets, done barefoot

  • 3s going up, 2s on ball of foot, 3s coming down

 

Benefits: maybe helpful

 

Side effects: common; delayed onset muscle soreness [8]

Rocker bottom shoe [1]

 

Benefits: maybe helpful

 

Side effects [9]: common; blisters, 7 in 100

poor balance or had a fall, 9 in 100

lower back or leg pain, 1 in 10

foot or ankle pain, 4 in 10

Local steroid injection [4]

  • See your GP to discuss injection options

  • Often done by a radiologist using ultrasound guidance

 

Benefits: maybe helpful

 

Side effects: common; pain during injection, 5 in 10 [4]

injection site redness and swelling [4]

uncommon; plantar fascia rupture, 3 in 1000 [4]

injection site infection, 4 in 1000 [4]

post injection pain, 4 in 100 [4] lasting 5-7 days [6]

uncommon; skin or fat pad atrophy [6]

Trigger point dry needling [10]

 

Benefits: maybe helpful

 

Side effects: common; needle site pain 3 in 10 [10]

post treatment bruising 3 in 100 [10]

Extracorporeal shock wave therapy [11]

 

Benefits: maybe helpful

 

Side effects: common; discomfort, pain swelling or bruise during or after treatment [11]

severe headache or migraine, 3 in 100 [4]

mild erythema, 7 in 100 [12]

mild throbbing sensation lasting average 5 days, 7 in 100 [12]

Moon boot (CAM walker) [5]

  • Used when high pain levels affect walking

  • Also used for plantar fascia tears and bruising of the heel bone

 

Benefits: helpful

 

Side effects: common; minor muscle or joint pain in the lower back or leg

Cognitive behavioural therapy (CBT) [13]

Graduated load and exposure to activities causing pain [13]

 

Benefits: unknown

 

Side effects: unknown

Surgery [5]

  • Should not be considered without the following:

  • Over 12 months of pain

  • Most treatment options listed as helpful and maybe helpful trialed without satisfactory improvement

 

Benefits: maybe helpful

 

Side effects [5]: common; persistent heel pain, 1 in 4

Swelling, fracture, nerve damage, arch flattening or infection

Disclaimer:

This management plan was developed for the exclusive use of Inform Podiatry patients based on an individual assessment and diagnosis.  Please see Inform Podiatry for your individual assessment, diagnosis and management plan before beginning any of these treatments.

 

References:

[1] Martin RL, et al, "Heel Pain—Plantar Fasciitis: Revision 2014 Clinical Practice Guidelines," 2014. 
[2] Podolsky R and Kalichman L, "Taping for plantar fasciitis," 2015. 
[3] Cleland JA, et al, "Manual Physical Therapy and Exercise Versus Electrophysical Agents and Exercise in the Management of Plantar Heel Pain: A Multicenter Randomized Clinical Trial," 2009. 
[4] David JA, et al, "Injected corticosteroids for treating plantar heel pain in adults (Review)," 2017. 
[5] Thomas JL, et al, "The Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline - Revision 2010," 2010. 
[6] Uden H, et al, "Plantar fasciitis – to jab or to support? A systematic review of the current best evidence," 2011. 
[7] Renan-Ordine R, et al, "Effectiveness of Myofascial Trigger Point Manual Therapy Combined With a Self-Stretching Protocol for the Management of Plantar Heel Pain: A Randomized Controlled Trial," 2011. 
[8] Rathleff MS, et al, "High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up," 2014. 
[9] Menz HB, et al, "Effectiveness of Foot Orthoses Versus Rocker-Sole Footwear for First Metatarsophalangeal Joint Osteoarthritis: Randomized Trial," 2016. 
[10] Cotchett MP, et al, "Effectiveness of Trigger Point Dry Needling for Plantar Heel Pain: A Randomized Controlled Trial," 2014. 
[11] Sun J, et al, "Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis A meta-analysis of RCTs," 2017. 
[12] Yucel I, et al, "Comparison of High-Dose Extracorporeal Shockwave Therapy and Intralesional Corticosteroid Injection in the Treatment of Plantar Fasciitis," 2010. 
[13] Cotchett M, et al, "The association between pain catastrophising and kinesiophobia with pain and function in people with plantar heel pain," 2017. 

 

 

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