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Plantar Fasciitis : Treatment and Medication

Author Information and Disclosures

Contents

Treatment

Prehospital Care:

  • ACE wraps may help keep the patient's foot immobilized in case of other injury.

Emergency Department Care:

  • Medical care in the ED should consist of patient education (see Patient Education) and NSAIDs.

Medication

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Nonsteroidal anti-inflammatory drugs are indicated to treat this disorder. They should be used for 2-4 weeks.

Drug Category: Nonsteroidal anti-inflammatory drugs (NSAIDs)

Decrease inflammatory responses and systemically interfere with events leading to inflammation.

Ibuprofen (Advil, Motrin) – Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. Used for analgesia and anti-inflammatory effect.
Adult Dose 200-800 mg PO q6-8h
Pediatric Dose 4-10 mg/kg PO q6-8h; not to exceed 50 mg/kg/d
Contraindications Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding; acetaminophen/NSAID-induced asthma or urticaria; CABG surgery
Interactions Coadministration with aspirin increases risk of serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently; may increase lithium levels; may increase nephrotoxicity with ACE inhibitors
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions Category D in third trimester of pregnancy; caution in congestive heart failure, hypertension, decreased renal and hepatic function; anticoagulation abnormalities, during anticoagulant therapy, peptic ulcer disease, GI bleeding, corticosteroid use, coagulopathy, asthma
 

Drug Category: Corticosteroids

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

Methylprednisolone (Depo-Medrol) – Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.
Adult Dose 40 mg intralesionally is typical dose
Pediatric Dose Not established
Contraindications Documented hypersensitivity; viral, fungal, or tubercular skin infections; joint infection
Interactions None reported when given as local injection
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Avoid repeated use; may cause local fat pad atrophy and rupture of plantar fascia; adverse reactions include infection at injection site and postinjection flare
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Bibliography

  1. Atkins D, Crawford F, Edwards J, Lambert M: A systematic review of treatments for the painful heel. Rheumatology (Oxford) 1999 Oct; 38(10): 968-73[Medline].
  2. Buchbinder R: Clinical practice. Plantar fasciitis. N Engl J Med 2004 May 20; 350(21): 2159-66[Medline].
  3. Cole C, Seto C, Gazewood J: Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician 2005 Dec 1; 72(11): 2237-42[Medline].
  4. Crawford F, Thomson C: Interventions for treating plantar heel pain. Cochrane Database Syst Rev 2003; CD000416[Medline].
  5. DiGiovanni BF, Nawoczenski DA, Lintal ME, et al: Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am 2003 Jul; 85-A(7): 1270-7[Medline].
  6. Hogan KA, Webb D, Shereff M: Endoscopic plantar fascia release. Foot Ankle Int 2004 Dec; 25(12): 875-81[Medline].
  7. Roxas M: Plantar fasciitis: diagnosis and therapeutic considerations. Altern Med Rev 2005 Jun; 10(2): 83-93[Medline].
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Synonyms And Related Keywords

plantar fasciitis, heel pain, jogger's heel, tennis heel, Policman's heel, bone spur, heel pain, pain on bottom of heel, exostosis, flat foot, highly-arched foot, excessively pronated foot, gait alteration, obesity, tight Achilles tendon, policeman's heel, pes planus, pes cavus

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Author Information and Disclosures

Author: Deepika Singh, MD, Staff Physician, Department of Emergency Medicine, Kings County Hospital Center

Coauthor(s): Mark A Silverberg, MD, FACEP, MMB, Assistant Professor of Emergency Medicine, State University of New York Downstate College of Medicine, Assistant Residency Director, Department of Emergency Medicine, Kings County Hospital; Leslie Milne, MD, Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine

Deepika Singh, MD, is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Nurses Association, Emergency Medicine Residents' Association, and Sigma Theta Tau International

Editor Information

Editor(s): Miguel C Fernandez, MD, FACEP, FAAEM, FACMT, Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Eric Legome, MD, Residency Director, Assistant Professor of Emergency Medicine, Department of Emergency Medicine New York University, New York University Hospital, Bellevue Hospital Center, Manhattan VA; John Halamka, MD, Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School; and Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital

 
 
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