Top treatments for plantar fasciitis - research update
Updated: 3 hours ago
THE PLANTAR FASCIITIS SELF-TREATMENT SERIES:
Self-treatment – overview of the treatment options (this article)
Plantar fasciitis is a pesky, painful, and persistent problem, but the good news is that the majority of the most effective treatments identified in the research are all things you can do at home. No having to take time off work and forking out to go and see a physio! This article will give you a complete list of the most effective treatments for plantar fasciitis that you can apply yourself.
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First, let’s get something out of the way: what you shouldn’t do when you’ve discovered that you have plantar fasciitis.
Treatments that don't work for plantar fasciitis
Your first instinct for treating very painful plantar fasciitis might be to reach for the anti-inflammatories. That will be of almost no use, especially if you’ve had the pain for a while. Other injuries usually start with inflammation before the regeneration phase of the injured tissue kicks in. Plantar fasciitis is different. It usually skips the inflammation and goes straight into a degeneration or breakdown phase.
Physiotherapists sometimes mete out two other treatments that won’t relieve or fix your plantar fasciitis: ultrasound and electrotherapy.
So, what to do about your pain?
Plantar fasciitis treatment: What is the most effective?
The treatment for plantar fasciitis has to be tailored to you. There will never be a single treatment to cure plantar fasciitis, simply because there can be so many different reasons why you develop heel pain. The plantar fasciitis treatments below can be roughly divided into treatments that reduce tension in the plantar fascia and treatments that strengthen the plantar fascia.
The most effective treatments according to the research are:
(see details under each section)
Once injured, your plantar fascia loses some of its strength and endurance. So now it struggles to cope with the load you place on it when you do your normal daily activities and sport. So, if you try and ignore the pain and just continue as normal, it usually just gets worse.
Remember, your plantar fascia supports your foot's arch and has to work whenever you stand, walk, run, or jump. To allow it time to recover, you have to reduce these activities to a level that does not cause your pain to increase significantly.
Complete rest is not needed nor is it useful, as it can cause your foot to lose more strength. You just have to limit the time you spend on your feet to what your foot can currently tolerate. So, observe how your pain reacts to the time you spend on your feet standing, walking, etc., and then temporarily limit your activities accordingly.
Top tip: Wearing good shoes and orthotics can reduce the strain on your plantar fascia and help your foot tolerate more activity. I discuss what to look out for in these lower down.
Stretching for plantar fasciitis
The calf muscles are connected to the plantar fascia via a fascia extension from the Achilles tendon, and I always find that they are tight in my patients who complain of heel pain.
Actually, all the muscles in the back of your leg are connected. This is why you should not only include stretches for the plantar fascia but also for the rest of the leg and back. A word of caution – you can make the symptoms worse if you over-stretch. Find a detailed explanation and demo of what stretches you should do for plantar fasciitis here.
Strengthening exercises for plantar fasciitis
The shape of the foot is determined by a passive support system (bones, ligaments, plantar fascia) as well as an active one (muscles and tendons). The plantar fascia is put under extra strain if the muscles in your foot and lower leg are weak or they cannot control your foot properly.
Strengthening and proprioceptive exercises can be very effective in the treatment of plantar fasciitis, but it is important that you do them at the correct intensity for the stage of your recovery.
If you would like help with your rehab exercises, check out the Plantar Fasciitis rehab plan in the Exakt Health app. I've helped to design the app to guide you through the rehab process from the moment your foot becomes painful all the way back to your sport. You can get one month free access when you use the Discount Code: MARYKE
Massage for plantar fasciitis
It is easy to massage your plantar fascia as well as your calf using balls of various sizes and foam rollers. The current research suggests that foam roller massage can be just as effective as a massage from a therapist when it comes to pain relief and increasing muscle length.
Massage for plantar fasciitis should include all the muscles along the back of your legs – not just the plantar fascia. I've created a detailed article with demo videos of how to massage yourself for plantar fasciitis.
Taping for plantar fasciitis
There are several taping techniques that you can try. The one thing that they all have in common is that they try and off-load the plantar fascia through supporting the inside arch of the foot and preventing the foot from rolling inwards excessively when you step on it.
One of the most commonly used is the Low Dye Taping technique. You can watch my variation of this technique below.
Orthotics or supportive insoles for plantar fasciitis
Foot orthotics come in various shapes and levels of support. I usually prescribe a medium density off-the-shelf orthotic that supports the inner arch of the foot. This reduces the load on the plantar fascia and gives it a chance to recover. Think of it as a "crutch" for the plantar fascia. Consult a podiatrist if you do lots of sport.
I usually advise my patients to test arch-supporting inserts first, but if they find them uncomfortable, soft gel inserts may be useful. The gel inserts don't support the arch but some patients seem to benefit from the extra cushioning under the heel. There is some research that shows that people with plantar fasciitis often also have a thinner fat pad (so less cushioning) under their heel bone - the gel insert may help with this.
I’ve selected the products below from Amazon, as they are similar to the ones I use in my clinic and appear to be good value for money.
Shoe selection for plantar fasciitis
Unsupportive and inflexible shoes provide very little arch support and put a much greater strain on the plantar fascia. Wear supportive trainers. Yes, I know they’re ugly. Yes, I do mean to work as well. No, not for always – just until the symptoms settle.
Two brands that I find provide a lot of cushioning but also support are Hokas and Asics. Here are two examples:
Night splints for plantar fasciitis
Researchers suspect that the plantar fascia shortens during the night and that the sudden stretch when you stand on it in the morning injures it anew. The theory behind night splints is that they prevent your plantar fascia from shortening during the night, which reduces the pain in the morning as well as the chance of injury. I do find these effective in patients with persistent symptoms.
Night splints come in various shapes and range from very rigid to soft. I prefer the Strassburg Sock for comfort, but I’ve also included an example of a more rigid splint below.
Low-level laser therapy for plantar fasciitis
Low-level laser may help to reduce pain, but the evidence to support this is not very strong. You will have to consult a physiotherapist for this treatment.
The less you weigh, the less force is transferred through your plantar fascia when you stand, walk, or run. As simple as that.
I hope you found this overview of treatments for plantar fasciitis helpful. Like I said, I’ve written in more detail about how you can treat yourself with stretches and massage – just follow the links below.
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About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.
Morrissey D, Cotchett M, Said J'Bari A, et al. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. British Journal of Sports Medicine 2021;55:1106-1118.
Belhan, O., Kaya, M., & Gurger, M. (2019). The thickness of heel fat-pad in patients with plantar fasciitis. Acta orthopaedica et traumatologica turcica, 53(6), 463-467.
McKeon, P. O., Hertel, J., Bramble, D., & Davis, I. (2015). The foot core system: a new paradigm for understanding intrinsic foot muscle function. British Journal of Sports Medicine, 49(5), 290.
Robroy L.M. et al., (2014). Heel Pain—Plantar Fasciitis: Revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33.