New treatments for plantar fasciitis

If you have plantar fasciitis pain, you're likely reminded of it as soon as you step out of bed in the morning.

Plantar fasciitis occurs when the plantar fascia — a band of tissue on the bottom of your foot — is somehow overloaded. The pain typically occurs near your heel bone and can range from a dull sensation to piercing pain.

Often, plantar fasciitis comes on gradually and affects only one foot, though it can start suddenly and affect both. It's usually worse in the morning, presumably because the plantar fascia tightens up and swells during the night when your foot is relaxed.

Most people with plantar fasciitis improve with basic care steps or physical therapy. But healing can be slow and frustrating.

If you're having trouble finding relief for a hard-to-treat case of plantar fasciitis, there's hope. Newer, nonsurgical therapy options may help.

New therapies for plantar fasciitis

If plantar fasciitis pain is disrupting your life — and you've already tried self-care measures and physical therapy — ask your doctor about these newer treatment options:

  • Ultrasonic fasciotomy and debridement. This technology was developed in part by Mayo Clinic doctors. It uses ultrasound imaging to identify degenerated tissues in the plantar fascia and to guide the procedure.

    Through a tiny incision, a narrow, needlelike surgical probe is inserted into the degenerated tissue. When activated, the probe tip vibrates rapidly, using ultrasonic energy to break up the damaged tissues, which are then suctioned away.

    The procedure usually takes just a few minutes, then the probe is removed and the incision is closed with surgical tape.

    After about 10 days of rest or restricted weight bearing, it's usually possible to return to your regular activities. It typically takes longer to get back to more-strenuous activities. Physical therapy may still be needed.

  • Needle fasciotomy with platelet-rich plasma injection. The first part of this procedure involves using ultrasound imaging and an injection-type probe to poke holes in damaged and degenerated plantar fascia tissue. This creates space for the platelet-rich plasma and may help to stimulate healing of the fascia.

    This is often followed by an injection of platelet-rich plasma (PRP) into the fascia. PRP is obtained from your own blood. Anti-inflammatory factors in PRP may help stimulate pain relief and healing in your foot.

Self-care and physical therapy comes first

Before trying new treatments, ask your doctor about basic care steps for relieving your foot pain. Most cases of plantar fasciitis go away within a year with self-care:

  • Wearing supportive footwear. Inside or out, wear supportive, cushioned shoes or slippers at all times. Replace worn-out or unsupportive shoes and keep footwear by your bed so that you can slip into them first thing in the morning.

    A semirigid, prefabricated shoe insert that provides arch support may improve cushion and support and help protect your plantar fascia.

  • Limiting aggravating activities. Avoid standing for long periods. And modify or stop physical activities that aggravate your symptoms. Instead, try activities that have a lower impact on your feet, like cycling or swimming.
  • Taking pain control measures. Apply a cloth-covered ice pack to your foot for 15 minutes, 3 to 4 times a day to provide initial pain relief. Nonprescription pain medication may relieve initial pain or a pain flare-up.
  • Losing weight, when necessary. It's a long-term proposition, but weight loss through improved diet and exercise helps ease strain on the feet.

If your foot pain hasn't improved after a couple of weeks of basic self-care, your doctor may refer you to a physical therapist. Physical therapy typically includes:

  • Exercises to stretch the plantar fascia and ankle muscles.
  • Strengthening of the ankle and foot muscles that support the arch, helping to decrease stress on your plantar fascia.
  • Using a night splint to reduce tightening of your fascia at night — or temporary use of a walking boot, cane or crutches to immobilize or restrict the amount of weight on the foot.