Houston Methodist. Leading Medicine

Foot FAQ

Question:

Is there anyone out there who knows how to treat plantar fasciitis? So far, I've seen six different people and all six have a different idea. None of which worked for me, by the way. I'm stuck -- can you help me?

Answer:

As you have discovered, plantar fasciitis can be very difficult to treat successfully. Most of the time it seems to take a combination of different treatment approaches to get the desired pain relief. But the problem is: the successful combination isn't the same for each person. So it becomes a process of trial and error. For those who may not know or understand what plantar fasciitis is, here's a quick review. Plantar fasciitis is a painful condition affecting the bottom of the foot. The plantar fascia (also known as the plantar aponeurosis) is a thick band of connective tissue. It runs from the front of the heel bone (calcaneus) to the ball of the foot. This dense strip of tissue helps support the arch of the foot by acting something like the string on an archer's bow. It is the source of the painful condition plantar fasciitis. Plantar fasciitis is the correct term to use when there is active inflammation. Plantar fasciosis is more accurate when there is no inflammation but chronic degeneration instead. Acute plantar fasciitis is defined as inflammation of the origin of the plantar fascia and fascial structures around the area. Plantar fasciitis or fasciosis is usually just on one side. In about 30 per cent of all cases, both feet are affected. To help you with your own process, there is a recent study done by a podiatrist with 35 years experience treating plantar fasciitis. One hundred patients received either ultrasound, orthotics (shoe inserts), injections, or arch supports. By comparing patient results with one treatment approach at a time, it was possible to rate them against each other. In terms of before and after pain, the group that got the most consistent pain relief was in the ultrasound treatment group. Eighty-one per cent (81%) of the patients in this group had less pain. After that the next best treatment for pain relief was injection (72 per cent) orthotics (64 per cent), and over-the-counter arch supports (35 per cent). The results were also measured by looking at how many patients in each group were completely pain free after treatment. When ranked this way, the best treatment methods were: orthotics (most number of patients who were pain free after treatment), then ultrasound, injection, and arch supports (least number of patients who had no pain). These outcomes confirm why many patients end up receiving multiple different treatments for painful plantar fasciitis. It seems to take a number of different approaches to really get the desired results. After 35 years of practice in podiatry and conducting various studies like this one, the author suggests the following treatment approach for most people with plantar fasciitis. First, ultrasound treatment along with arch supports. If foot or heel pain persists, then a single cortisone injection is given. When every treatment possibility and combination has been tried without success, then surgery is the final treatment approach. Gerald T. Kuwada, DPM, NMD. A Prospective Randomized Trial Using Four Treatment Modalities for the Treatment of Plantar Fasciitis. In The Foot and Ankle Online Journal. August 2011. Vol. 4. No. 8. Pdf.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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