Plantar fasciitis: What are the best treatment options?

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 feet. It's usually worse in the morning, probably because the plantar fascia tightens up and swells during the night when the 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 hard-to-treat plantar fasciitis, there's hope. Newer, nonsurgical therapy options may help.

Recent 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 health care provider about these treatment options:

• Ultrasonic fasciotomy and debridement. This technology was developed in part by Mayo Clinic doctors. During the procedure, ultrasound imaging is used to identify degenerated tissues in the plantar fascia and to guide the treatment.

  Through a tiny incision, a narrow, needlelike surgical probe is inserted into the degenerated tissue. When activated, the probe tip vibrates, using ultrasonic energy to break up the damaged tissues. The damaged tissues 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 a few weeks of rest or restricted weight bearing, it's usually possible to return to regular daily 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 (PRP). Like the above procedure, ultrasound imaging is used to assess the degenerated areas of plantar fascia and then guide the treatment.

  During the procedure, a needle is used to poke holes and inject PRP into the damaged and degenerated plantar fascia tissue. This stimulates a new healing response.

  PRP comes 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 provider about basic care steps for relieving your foot pain. Most cases of plantar fasciitis go away within a year with these self-care steps:

• Wearing supportive footwear. Inside or out, wear supportive, cushioned shoes or slippers at all times. Replace shoes that are worn out or not supportive. 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 activities that make symptoms worse. Avoid standing for long periods. And modify or stop physical activities that worsen 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. Pain medicine you can buy off the shelf may relieve initial pain or a pain flare-up.
• Losing weight, when necessary. It's a long-term plan, 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 provider 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.