Plantar Fasciitis

Stretching MOST IMPORTANT: calf stretches (gastrocnemius—knee straight; soleus—knee bent, hold 30 seconds, repeat 3-5x, perform 3-5x/day minimum—tight calves worsen plantar fasciitis), plantar fascia stretches (pull toes back toward shin while knee straight, hold 10 seconds, repeat 10x, 3-5x/day), stretch first thing in morning before standing (reduces morning pain), Night splints (hold foot in dorsiflexion overnight, prevents fascia tightening during sleep, reduces morning pain, 70-80% improve with night splints), Footwear: supportive shoes with good arch support, cushioned heel, avoid flat shoes, flip-flops, worn-out shoes, replace running shoes every 300-500 miles, consider custom orthotics if biomechanical issues (flat feet, high arches), Ice: ice massage (freeze water in small cup, massage heel in circular motion 5-10 min, 2-3x/day—especially after activity), ice bottle roll (freeze water bottle, roll foot over it 10-15 min), Rest and activity modification: avoid prolonged standing, walking, running during acute phase, cross-training (swimming, cycling—non-impact activities), gradual return to activity (don't increase mileage >10% per week), Strengthen: toe curls, marble pickups, towel scrunches (strengthen intrinsic foot muscles—support arch, reduce load on fascia), heel raises (strengthen calf muscles), Weight loss if overweight (most important for long-term resolution), Taping: athletic tape or KT tape (supports arch, reduces load on fascia—taught by physical therapist), Avoid: walking barefoot (especially on hard surfaces), high heels, flat shoes without support, sudden increases in activity, Massage: golf ball or frozen water bottle roll (self-massage plantar fascia), deep tissue massage by therapist, Corticosteroid injection: if conservative treatment insufficient after 3-6 months—provides temporary relief (3-6 months), allows better participation in PT, risks (fascia rupture 10%—devastating, causes flat foot; fat pad atrophy—worsens pain long-term; infection—rare), limit to 2-3 injections maximum, Extracorporeal Shockwave Therapy (ESWT): for chronic, refractory plantar fasciitis (failed 6+ months conservative treatment)—non-invasive, high-energy sound waves stimulate healing, 60-80% success rate, 3-5 treatments, expensive ($1500-3000), FDA-approved, PRP (Platelet-Rich Plasma) injection: regenerative option—stimulates healing of degenerative fascia, 70-80% success rate, evidence stronger than corticosteroid (which may worsen degeneration), expensive, 1-3 injections, Prolotherapy: injections of dextrose solution—stimulates healing response, cheaper than PRP, evidence mixed, multiple injections needed, Surgery (plantar fascia release—partial cutting of fascia): last resort if 12+ months aggressive conservative treatment fails—success rate 70-80%, risks (nerve damage, infection, arch collapse, chronic pain, fascia rupture), long recovery 2-6 months, Most cases (90%) resolve with conservative treatment within 12 months (stretching, orthotics, weight loss, activity modification, night splints)—patience and consistency critical.