Left without treatment, plantar fasciitis may take 6 months to 2 years to heal completely on its own. For most people the pain may be extremely uncomfortable and they will seek treatment after a few months. Treatment for this condition begins with conservative care and may advance to surgical treatment is the problem does not resolve. Plantar fasciitis is a common condition amongst very athletic people as well as overweight people. The first line of treatment consists of rest, icing, stretching exercises, and anti-inflammatory medications. When the plantar fascia is inflamed decreasing physical activity and resting will help to reduce inflammation quicker then continued activity. If the pain is bad your doctor may give you a walking cast or a soft cast to wear in order to decrease the pressure on the heel area. Some may recommend using crutches to help with walking till the pain is reduced. Icing the heel daily will help to reduce inflammation of the plantar fascia. A good way to ice the plantar fascia is to fill an empty plastic water bottle with water and put it in the freezer. You can then roll your heel over the ice for 10-15 minutes at the end of the day. Ibuprofen or a Medrol dose pack is commonly used along with stretching and icing to control the original inflammation of the plantar fascia.
A tight Achilles tendon is a common co-morbidity with patients afflicted with plantar fasciitis. Stretching out the Achilles tendon with help to decrease the pull of the Achilles on the calcaneus and take the tension off the plantar fascia. Stretching before you get out of bed can help take the painful edge out of the first few steps in the morning as well. Take a towel and place the belly of the towel around your foot. Grab the ends of the towel with your hands and pull back. You can also take a tennis ball and roll your foot over it for a minute or so before you get out of bed. When you sleep your foot is usually in a position which allows the plantar fascia to contract, making the first few steps in the morning more painful as you stretch that contraction out. When stretching is no longer enough to relieve the pain of the plantar fascia, you can try a night splint. A night splint will keep the plantar fascia stretched out the entire night so no contraction occurs, and there is less pain upon the first steps in the morning.
For patients with more severe heel pain, or who have tried conservative treatment with minimal relief of pain your Podiatrist may recommend a cortisone injection. These injections contain a local anesthetic along with a steroid to provide both immediate and long term relief. One injection may give one to three months of relief. It is not recommended to give more then 3ml’s of any one steroid in the same place within a 6 months to 1 year time frame, so most Podiatrists with only give .5ml’s-1ml of steroid in each injection so multiple shots may be given.
Supporting the heel and the arch of the foot is commonly used in conjunction with other conservative treatment methods. An arch support will prevent the arch from collapsing and prevent tension on the plantar fascia. There are many types of arch supports out there that may be used for this purpose. In patients that find that the arch supports relieve their pain, their podiatrist may prescribe a custom orthotic to use to prevent the abnormal motion that caused the irritation to begin with.When all methods of conservative treatment fail, and the pain is still unbearable, your podiatrist may recommend an endoscopic plantar fascial release (EPF). An EPF will release all of the medial and central bands of the plantar fascia. Some of the lateral band may be released or left intact depending on how extensive the pain is at this point. This surgical procedure is quick and takes less then an hour in the operating room.