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What is the best treatment for plantar fasciitis?

Article Excerpt
* EVIDENCE-BASED ANSWER

Mechanical therapies--such as taping, tension night splinting, and rigid arch support--are the most effective treatment for plantar fasciitis (strength of recommendation: A, based on randomized controlled trials). If limited or no improvement is observed after 6 months of mechanical therapy, extracorporeal shock wave therapy (Orthotripsy) is the next treatment of choice (strength of recommendation [SOR]: A, based on meta-analysis of randomized controlled trials). When mechanical therapies and extracorporeal shock wave therapy have failed for more than 1 year, surgical treatment may be considered (SOR: C, based on a case-series study).

* EVIDENCE SUMMARY

In a prospective, observer-blinded study, 103 subjects were randomized to 1 of 3 treatment categories: anti-inflammatory (etodolac plus corticosteroid injections); accommodative (viscoelastic heel cup); or mechanical (low-dye tapping for 1 month followed by rigid custom orthosis for 2 months). (1) After 3 months of treatment, 70% of patients in the mechanical treatment group rated their functional outcome as excellent, compared with only 33% of the anti-inflammatory group and 30% of the accommodative group (P=.005). Additionally, the mechanically treated group was less likely to terminate treatment early because of treatment failure (P<.001).

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