NYU Langone’s specialists offer a variety of nonsurgical therapies for plantar fasciitis, a painful condition of the heel. Most people find relief with these treatments. However, if pain doesn’t improve after 6 to 12 months of the following approaches, your doctor may discuss surgical options.
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Your doctor works with you to reduce inflammation of the plantar fascia. Reducing inflammation can help to alleviate pain associated with the condition.
Applying ice to the injured tissue, massaging the area, or using a combination of both approaches 2 to 3 times daily for 5 to 10 minutes at a time can help to treat plantar fasciitis. Rolling the bottom of your foot on a plastic ball covered in soft spikes is an easy form of massage your doctor may recommend.
A 10- to 14-day course of nonsteroidal anti-inflammatory inhibitors such as naproxen or ibuprofen can also help to reduce inflammation and pain. Reducing the amount of time you spend on your feet may also help the plantar fascia recover.
If these approaches do not work, your doctor may recommend wearing a walking boot to help immobilize the injured foot and to reduce the amount of pressure placed on it while walking. You may need to wear the walking boot for about three weeks.
You may also work with a physical therapist at NYU Langone Orthopedic Center to stretch the plantar fascia, the Achilles tendon, and calf muscles. Exercises to strengthen muscles in the foot and the calf muscle are also beneficial. The physical therapy schedule varies depending on your needs.
Our specialists work with you to modify your physical activity to reduce the amount of stress on the sole of the foot. For example, if you participate in high-impact exercise such as running, your doctor and physical therapist may recommend that for a short time you switch to lower-impact activities such as cycling, swimming, or using the elliptical machine.
Your physical therapist may ask you to continue the stretching and strengthening exercises at home on a daily basis.
Your treatment may include orthotics, such as silicon heel cup inserts to place in your shoes. These inserts cushion and elevate your heels, which takes pressure off the plantar fascia.
Your doctor may suggest wearing a night splint on your injured foot for six to eight weeks to help stretch the plantar fascia. Most people sleep with their feet in a position that shortens the plantar fascia. Splints help to keep the injured foot flexed, stretching the ligament.
Corticosteroids, also just called steroids, are powerful anti-inflammatory medications that alleviate pain and reduce inflammation. Your doctor typically gives corticosteroid injections for plantar fasciitis while looking at real-time ultrasound images of your foot, so that the treatment can be delivered directly into the plantar fascia.
A small amount of anesthetic may be given with corticosteroids. The anesthetic can provide immediate pain relief that wears off after a few hours. The corticosteroids begin to work two to three days later.
Most people return home or to work immediately after the injection. Your doctor may recommend applying ice to the bottom of the foot two or three times a day or taking an over-the-counter medication to relieve pain and reduce swelling.
Your doctor may give the injection no more than once or twice because of potential side effects such as weakening of the fascia.
If corticosteroid injections don’t reduce inflammation and pain in the plantar fascia, your doctor may discuss platelet-rich plasma injections with you. Platelet-rich plasma (PRP) is made of blood cells called platelets. Platelets release substances called growth factors, which stimulate healing.
In this procedure, your doctor first takes a small amount of blood from a vein in your arm and uses a centrifuge machine to separate the platelets and growth factors from other blood components. The process takes about 15 minutes. The doctor then injects this platelet-rich liquid, called plasma, directly into the plantar fascia, using ultrasound imaging to guide the injection.
The injection site may be sore for a few days to a week after treatment. Your doctor may recommend that you avoid strenuous activity and wear a walking boot to keep pressure off the foot. You may also need to avoid anti-inflammatory medications for two to four weeks after an injection, while the plantar fascia heals. The platelet-rich plasma injection stimulates the body’s inflammatory response, an important part of healing that could be inhibited if anti-inflammatory drugs are taken.
You may start to experience improvements in your injury four to eight weeks after injection. The treatment can be repeated if your plantar fasciitis returns.
Emerging evidence shows that a botulinum toxin injection may help to relax the plantar fascia, alleviating pain caused by plantar fasciitis. Botulinum toxin, more commonly known as Botox, is a protein produced by a type of bacterium, Clostridium botulinum. Your doctor may talk to you about this option for treating plantar fasciitis.
Shock wave therapy is a noninvasive, in-office procedure that may help the plantar fascia to heal. NYU Langone doctors use extracorporeal pulse technology, or EPAT, which consists of special pressure waves that may stimulate the production of the protein collagen, helping to repair damaged tissue. Treatment for plantar fasciitis occurs once a week for five weeks. Each session takes about 10 to 15 minutes. Improvements in pain and inflammation may be seen at four to six weeks after treatment. Shock wave therapy does not cause pain at the treatment site.
Acupuncture, the use of thin needles inserted into the skin, may provide short-term pain relief from plantar fasciitis. Our practitioners use trigger point acupuncture, which targets specific areas of the foot and ankle to release tightness in the foot muscles and plantar fascia. Acupuncture is offered as part of NYU Langone’s outpatient integrative health services.
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