A Guide To Conservative Care For Plantar Heel Pain

Jamie Yakel, DPM

   Stretching is one of the hallmark treatments in treating plantar fasciitis. By stretching the plantar fascia and/or gastrocsoleus complex, the goal is to relieve the stress on the plantar fascia. It is difficult to determine the effectiveness of stretching alone since most studies used other interventions along with stretching.

   In one of the most recent studies, Bolivar and coworkers found that not only was the triceps surae tight in patients with plantar fasciitis but the hamstrings were tight as well.22 Both areas should be in a stretching protocol but there are currently no long-term studies to determine the effectiveness of this approach. Patients with hamstring tightness are also reportedly 8.7 times more likely to have plantar fasciitis.23

   DiGiovanni and colleagues compared a program of non-weightbearing plantar fascia stretches to Achilles tendon stretching.24 While both groups reported significant improvements at eight weeks, there was greater pain relief in the patients who performed the plantar fascia stretches. In their study of sustained Achilles tendon stretching versus intermittent stretching, Porter and his co-authors concluded that it was more critical that patients were stretching daily and that the type of stretching was not important.25 There are currently no randomized control trials that compare the effectiveness of two different gastrocsoleus methods of stretching.

Can Night Splints Have An Impact?

Night splints are another treatment option that can be effective depending on patient adherence. The goal is to prevent plantarflexion of the ankle during sleep, allowing the plantar fascia to heal near or at its functional configuration. Batt and colleagues performed a randomized, controlled trial in which one group used night splints, heel pads, ibuprofen and gastrocsoleus stretching, and the other group received the same treatments without the night splint.26 The control group patients who were not responding after eight to 12 weeks subsequently crossed over to the night splint group, in which 72.7 percent were cured in 13 weeks.

   When clinicians use night splints in combination with other treatment modalities like prefabricated orthotics, stretching and NSAIDs, they can be effective adjunctive treatment options.27,28

What You Should Know About Corticosteroid Injections

Corticosteroid injections are a common choice for treating plantar fasciitis. Like many of the other plantar fasciitis studies, most studies using corticosteroid injections used them in conjunction with other modalities. Despite the common use of corticosteroid injections, very few randomized, controlled trials exist to support their use versus placebo.

   One trial compared prednisolone 25 mg and lidocaine to lidocaine (placebo) and found significant pain reduction after one month with the prednisolone group.29 Another study found no statistical difference between 25 mg of hydrocortisone and normal saline two months after treatment.30

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