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Plantar Fasciitis Management Plan
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]
May work best with orthoses replacing the shoe inner
See a rocker bottom shoe store or online
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]
See a registered health professional who does either dry needling or acupuncture
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.