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Plantar fasciitis - Management
Basis for recommendation
Analgesia and injected corticosteroids are recommended by an American evidence-based guideline [McPoil et al, 2008], an electronic guideline [Foye and Stitik, 2008], and a narrative review [Neufeld, 2008].
Analgesia and NSAIDs
- CKS found no evidence from randomized controlled trials to verify the efficacy of analgesics or NSAIDs in the treatment of plantar fasciitis, although they have a plausible mechanism of action to relieve symptoms (but not the cause).
- Paracetamol, with the optional addition of codeine, is the standard treatment for pain.
- Ibuprofen is recommended as the NSAID of choice in the absence of trial data. It is generally accepted as having a relatively good safety profile, is widely used, and is available over-the-counter.
Injected corticosteroids
- There is little consensus from specialists (e.g. orthopaedic and podiatric consultants) on the optimal use of injected corticosteroids for plantar fasciitis. CKS recommendations are based on historical practice, bearing in mind that clinical judgement should always be used on an individual basis.
- The available trial evidence to support the use of injected corticosteroids in plantar fasciitis is generally poor, as a prevailing presumption of its efficacy means that placebo-controlled trials have not been conducted.
- In the absence of direct evidence, knowledge of pharmacological effects, together with extrapolated data from other conditions, strongly supports the effectiveness of injected corticosteroids, and they are almost universally recommended by experts.
- Potential harms of injected corticosteroids include plantar fat-pad degeneration or plantar fascia rupture.
- Administration of an injected corticosteroid can be painful and there are risks involved, so it is generally recommended that all suitable and available conservative measures should have been tried before injections are considered. However, CKS recognizes that in practice more immediate and effective treatment may be required for some individuals, especially for people who are required to be 'on their feet' as part of their occupation.
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