Plantar fasciitis is unlikely to go away on its own

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Health tips: Plantar fasciitis

Dear Reader,

The plantar fascia is a band of tissue that connects your heel to your toes. It supports the arch of your foot and absorbs the stress that’s placed on your feet. When too much pressure damages or tears that tissue, inflammation can occur — a condition known as plantar fasciitis.

Plantar fasciitis is marked by intense pain near your heel and sometimes stiffness. The pain is usually the worst with the first few steps after awakening, although it also can be triggered by long periods of standing or when you get up from sitting.

Covering the bases with home care: A first step toward caring for the plantar fascia is to wear supportive shoes. Mayo Clinic experts recommend these additional steps for caring for the plantar fascia:

Use ice packs 3 to 4 times a day or roll a frozen water bottle under the foot.
Use arch supports, called orthotics, in shoes; or use a heel cup.
Stretch the arches of the feet with home exercises.
Take a break from activities that cause pain.
Take nonprescription pain relievers such as acetaminophen.

The role of physical therapy: If home care hasn’t improved your pain after a couple of weeks, your provider may refer you to physical therapy. Physical therapists often combine an exercise program with methods such as massage, ice, therapeutic ultrasound and other therapies such as:

Night splints — A splint holds the foot in a position that provides a prolonged stretch to the plantar fascia.
Limited weight bearing — The brief use of a walking boot, cane or crutches to limit the weight-bearing load on your foot.
Iontophoresis — The therapist may apply an electrode soaked in a steroid solution to the affected area. This reduces inflammation without the need for an injection.

When more relief is needed: If the steps above aren’t enough, talk to your healthcare provider about your options. These may include:

Steroid injection — Injection of corticosteroids, often done under ultrasound guidance, typically reduces pain for 4 to 12 weeks.
Dry needling — This procedure involves making small holes in the tendon with a small needle to stimulate certain factors involved in tendon healing.
Platelet-rich plasma (PRP) injections — Platelet-rich plasma obtained from your own blood can be injected into the tender area to possibly promote tissue healing.
Minimally invasive tenotomy (Tenex system) — Ultrasound imaging is used to guide a needle-like probe through a small incision and into the plantar fascia to break up the damaged tissue.
Shock wave therapy — High-energy sound waves are directed to the painful area to stimulate healing.
Very rarely, your provider may recommend surgery to detach the plantar fascia from the heel bone to relieve tension.

Researchers have looked at many other treatments in small clinical trials. These include Botox injections, the delivery of cold to destroy inflamed nerve fibers (cryotherapy) and low-intensity laser therapy. However, these options may not be readily available, are generally more expensive and are of uncertain benefit.

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