Initial treatment of plantar fasciitis consists of stretching the Achilles and plantar fascia, padding and strapping of the arch, supportive shoe gear, rest and avoidance of high-impact activities, orthotics, oral nonsteroidal anti-inflammatory drugs, night splints, and corticosteroid injections. Instructions to stretch the Achilles and plantar fascia is as follows: stand an arm’s length from a wall, place your right foot behind your left, slowly and gently bend your left leg forward, keep your right knee straight and your right heel on the ground, hold the stretch for 15 to 30 seconds and release, reverse the position of your legs, and repeat. Patients typically respond to treatment within 6 weeks; if the patient experiences improvement in symptoms, the treatment should be continued until resolution. Extracorporeal shock wave therapy, iontophoresis, botulinum toxin injections, and platelet-rich plasma (PRP) injections have shown promising results but have not been supported with good-quality evidence. Limited evidence supports the conclusion that any of the newly mentioned modalities are superior to steroid injections or other conservative methods of treatment.
Plantar fasciotomy done through either open or endoscopic technique may be effective for plantar fasciitis that does not respond to conservative treatment after 1 year.