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Plantar fasciitis - Management
Basis for recommendation
The recommendations for information and advice for people with plantar fasciitis are consistent with an American evidence-based guideline [McPoil et al, 2008], and a UK guideline [ARC, 2004a].
Prognosis
- The longer-term clinical course of plantar fasciitis is good. One prospective survey found that over 80% of people achieved complete resolution of their symptoms after a mean of about 2 years of follow-up [Wolgin et al, 1994]. Other studies with shorter follow-up times have indicated that most people recover fully within 1 year [McPoil et al, 2008].
Self-care measures to improve healing and reduce recurrence
- Foot rest, and the use of shoes with good support, are recommended as pragmatic measures to relieve foot pain and promote healing of the fascia [ARC, 2004a]. CKS identified no controlled trials to verify the effectiveness of good footwear, but such footwear has received positive feedback from a user survey [Wolgin et al, 1994]. Walking barefoot is also likely to aggravate foot pain.
- Stretching exercises are generally recommended by most experts as the mainstay of conservative treatment for plantar fasciitis. However, there is a lack of quality evidence from randomized controlled trials (RCTs) to support the use of exercise, with one short-term placebo-controlled trial finding no benefit [Radford et al, 2007]. Despite this, stretching exercises are perceived to be the intervention of most benefit by people with plantar fasciitis [Wolgin et al, 1994].
- Orthoses are widely recommended on the basis they benefit foot posture and aid fascia healing. Although there is limited evidence from RCTs that prefabricated orthoses are equivalent to custom-made orthoses, a lack of placebo-controlled trials means their overall effectiveness is uncertain. Evidence from one RCT (n = 101) suggests magnetic insoles are no more effective than ordinary insoles, so these should be avoided on a cost basis [Winemiller et al, 2003].
- Obesity (body mass index greater than 30 kg/m2) has been associated with poor prognosis of plantar fasciitis, possibly by causing more pressure on the plantar fascia [Wearing et al, 2006]. Therefore it is recommended that overweight people with plantar fasciitis should lose weight, which is also likely to have other health benefits [McPoil et al, 2008].
Symptomatic relief
- Ice is believed to cool the fascia and causes vasoconstriction, reducing inflammatory processes.
- Analgesics are recommended on the basis of limited evidence. See Management for more information.
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