Editing Plantar fasciitis (section)

==Treatment==
===Non-surgical===
About 90% of plantar fasciitis cases improve within six months with conservative treatment,<ref name="Zhiyun_2013"/> and within a year regardless of treatment.<ref name="Goff_2011"/><ref name="Tahririan_2012"/>

The recommended first treatment is a four- to six-week course which combines three elements: daily [[stretching]], daily foot taping (using a special tape around the foot for supporting the [[Arches of the foot|arch]]) and individually tailored education on choosing footwear and other ways of managing the condition.<ref name="NIHR_2021">{{Cite journal |date=2022-07-21 |title=A best practice guide for managing plantar heel pain |url=https://evidence.nihr.ac.uk/alert/best-practice-guide-for-plantar-heel-pain/ |journal=NIHR Evidence |type=Plain English summary |language=en |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_52045|s2cid=251780089 |url-access=subscription }}</ref><ref name="Morrissey_2021">{{cite journal | vauthors = Morrissey D, Cotchett M, Said J'Bari A, Prior T, Griffiths IB, Rathleff MS, Gulle H, Vicenzino B, Barton CJ | display-authors = 6 | title = Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values | journal = British Journal of Sports Medicine | volume = 55 | issue = 19 | pages = 1106–1118 | date = October 2021 | pmid = 33785535 | pmc = 8458083 | doi = 10.1136/bjsports-2019-101970 }}</ref>

Reduction in pain and stress on the plantar fascia can be done by strengthening the muscles in the foot that support the arches through barefoot exercising, without footwear, compared to exercising in common footwear.<ref>{{Cite journal | vauthors = Kamalakannan M, Dass D |date=2019 |title=Efficacy of Bare foot Exercise Versus Common Footwear Exercise in Subjects with Plantar Fasciitis |url=http://www.indianjournals.com/ijor.aspx?target=ijor:rjpt&volume=12&issue=3&article=010 |journal=Research Journal of Pharmacy and Technology |language=en |volume=12 |issue=3 |pages=1039 |doi=10.5958/0974-360X.2019.00171.9 |s2cid=181730696 |issn=0974-3618|url-access=subscription }}</ref>

If plantar fasciitis fails to respond to conservative treatment for at least three months, then [[extracorporeal shockwave therapy]] (ESWT) may be considered.<ref name="NIHR_2021" /><ref name="Morrissey_2021" /> Evidence from [[meta analysis|meta-analyses]] suggests significant pain relief lasts up to one year after the procedure.<ref name="Zhiyun_2013" /><ref name="Aqil_2013">{{cite journal | vauthors = Aqil A, Siddiqui MR, Solan M, Redfern DJ, Gulati V, Cobb JP | title = Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs | journal = Clinical Orthopaedics and Related Research | volume = 471 | issue = 11 | pages = 3645–3652 | date = November 2013 | pmid = 23813184 | pmc = 3792262 | doi = 10.1007/s11999-013-3132-2 }}</ref>  However, debate about the therapy's efficacy has persisted.<ref name="Lareau_2014" /> ESWT is performed with or without [[anesthesia]] though studies suggest giving anesthesia diminishes the procedure's effectiveness.<ref name="Wang_2012">{{cite journal | vauthors = Wang CJ | title = Extracorporeal shockwave therapy in musculoskeletal disorders | journal = Journal of Orthopaedic Surgery and Research | volume = 7 | issue = 1 | pages = 11 | date = March 2012 | pmid = 22433113 | pmc = 3342893 | doi = 10.1186/1749-799X-7-11 | doi-access = free }}</ref> Complications from ESWT are rare and typically benign when present.<ref name="Wang_2012" /> Known complications of ESWT include the development of a mild [[hematoma]] or an [[ecchymosis]], [[Erythema|redness]] around the site of the procedure, or [[migraine]].<ref name="Wang_2012" />
[[File:Orthese am Strand.jpg|thumb|270x270px|Customised foot orthoses can offer short-term pain relief.]]
The third line of treatment, if shockwave therapy is not effective after around 8 weeks, is using customised foot [[Orthotics|orthoses]] which can offer short-term relief from pain.<ref name="NIHR_2021" /><ref name="Morrissey_2021" />

Affected people use further different treatments for plantar fasciitis but many have little evidence to support their use and are not adequately studied.<ref name="Goff_2011" />

Other conservative approaches include rest, [[massage]], heat, ice, and [[calf raises|calf-strengthening exercises]], weight reduction in the overweight or obese, and [[nonsteroidal anti-inflammatory drugs]] (NSAIDs) such as [[aspirin]] or [[ibuprofen]].<ref name="Tu_2011" /><ref name="Molloy_2012" /><ref>{{cite web |year=2010 |title=Plantar Fasciitis and Bone Spurs |url=http://orthoinfo.aaos.org/topic.cfm?topic=a00149 |url-status=live |archive-url=https://web.archive.org/web/20140616011951/http://orthoinfo.aaos.org/topic.cfm?topic=a00149 |archive-date=16 June 2014 |access-date=24 June 2014 |publisher=American Academy of Orthopaedic Surgeons}}</ref> The use of NSAIDs to treat plantar fasciitis is common, but their use fails to resolve the pain in 20% of people.<ref name="Molloy_2012" />

[[Corticosteroid]] injections are sometimes used for cases of plantar fasciitis that have proven resistant to more conservative measures. There is tentative evidence that injected corticosteroids are effective for short-term pain relief up to one month, but not after that.<ref>{{cite journal | vauthors = David JA, Sankarapandian V, Christopher PR, Chatterjee A, Macaden AS | title = Injected corticosteroids for treating plantar heel pain in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 6 | pages = CD009348 | date = June 2017 | pmid = 28602048 | pmc = 6481652 | doi = 10.1002/14651858.CD009348.pub2 }}</ref>

Another treatment technique is known as plantar [[iontophoresis]]. This technique involves applying anti-inflammatory substances such as [[dexamethasone]] or [[acetic acid]] topically to the foot and transmitting these substances through the skin with an electric current.<ref name="Molloy_2012"/> Some evidence supports the use of night splints for 1–3 months to relieve plantar fasciitis pain that has persisted for six months.<ref name="Tahririan_2012"/> The night splints are designed to position and maintain the ankle in a neutral position, thereby passively stretching the calf and plantar fascia during sleep.<ref name="Tahririan_2012"/>

===Surgery===
Plantar [[fasciotomy]] is a surgical treatment and the last resort for refractory plantar fasciitis pain. If plantar fasciitis does not resolve after six months of conservative treatment, then the procedure is considered as a last resort.<ref name="Goff_2011"/><ref name="Tu_2011"/> Minimally invasive and endoscopic approaches to plantar fasciotomy exist but require a specialist who is familiar with specific equipment. The availability of these surgical techniques is limited as of 2012.<ref name="Cutts_2012"/> A 2012 study found 76% of people who underwent endoscopic plantar fasciotomy had complete relief of their symptoms and had few complications (level IV evidence).<ref name="Lareau_2014"/> [[Heel spur]] removal during plantar fasciotomy does not appear to improve the surgical outcome.<ref name="Thomas_2010">{{cite journal | vauthors = Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, Weil LS, Zlotoff HJ, Bouché R, Baker J | display-authors = 6 | title = The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010 | journal = The Journal of Foot and Ankle Surgery | volume = 49 | issue = 3 Suppl | pages = S1-19 | date = May–June 2010 | pmid = 20439021 | doi = 10.1053/j.jfas.2010.01.001 | s2cid = 3199352 | doi-access = free }}</ref>

Plantar heel pain may occur for multiple reasons. In select cases, surgeons may perform a release of the [[lateral plantar nerve]] alongside the plantar fasciotomy.<ref name="Cutts_2012"/><ref name="Thomas_2010"/> Possible complications of plantar fasciotomy include nerve injury, instability of the [[medial longitudinal arch]] of the foot,<ref name="Tweed_2009">{{cite journal | vauthors = Tweed JL, Barnes MR, Allen MJ, Campbell JA | title = Biomechanical consequences of total plantar fasciotomy: a review of the literature | journal = Journal of the American Podiatric Medical Association | volume = 99 | issue = 5 | pages = 422–430 | date = September–October 2009 | pmid = 19767549 | doi = 10.7547/0990422 }}</ref> fracture of the [[calcaneus]], prolonged recovery time, infection, rupture of the plantar fascia, and failure to improve the pain.<ref name="Goff_2011"/> [[Radiofrequency ablation|Coblation]] surgery has recently been proposed as an alternative surgical approach for the treatment of recalcitrant plantar fasciitis.<ref name="Thomas_2010"/>

Gastrocnemius recession is a surgical procedure that involves lengthening the [[gastrocnemius muscle]] to reduce tension in the Achilles tendon and plantar fascia. This technique improves the ankle's range of motion, reduces pain, and can help patients return to work, sports, and weight-bearing activities more comfortably. The procedure is particularly beneficial for individuals with limited ankle dorsiflexion (upward bending) due to tight calf muscles, which can exacerbate plantar fasciitis symptoms.<ref>{{cite journal | vauthors = Arshad Z, Aslam A, Razzaq MA, Bhatia M | title = Gastrocnemius Release in the Management of Chronic Plantar Fasciitis: A Systematic Review | journal = Foot & Ankle International | volume = 43 | issue = 4 | pages = 568–575 | date = April 2022 | pmid = 34766860 | pmc = 8996295 | doi = 10.1177/10711007211052290 }}</ref>

===Unproven treatments===
[[Botulinum toxin]] A injections as well as similar techniques such as [[platelet-rich plasma]] injections and [[prolotherapy]] remain controversial.<ref name="Tahririan_2012"/><ref name="Lareau_2014"/><ref name="Molloy_2012"/><ref name=Monto>{{cite journal | vauthors = Monto RR | title = Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis | journal = Foot & Ankle International | volume = 35 | issue = 4 | pages = 313–318 | date = April 2014 | pmid = 24419823 | doi = 10.1177/1071100713519778 | s2cid = 206652513 }}</ref>

[[Dry needling]] is also being researched for treatment of plantar fasciitis.<ref>{{cite journal | vauthors = Cotchett MP, Landorf KB, Munteanu SE, Raspovic A | title = Effectiveness of trigger point dry needling for plantar heel pain: study protocol for a randomised controlled trial | journal = Journal of Foot and Ankle Research | volume = 4 | issue = 1 | pages = 5 | date = January 2011 | pmid = 21255460 | pmc = 3035595 | doi = 10.1186/1757-1146-4-5 | doi-access = free }}</ref> A [[systematic review]] of available research found limited evidence of effectiveness for this technique.<ref name=Cotchett/> The studies were reported to be inadequate in quality and too diverse in methodology for a firm conclusion.<ref name=Cotchett>{{cite journal | vauthors = Cotchett MP, Landorf KB, Munteanu SE | title = Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review | journal = Journal of Foot and Ankle Research | volume = 3 | issue = 1 | pages = 18 | date = September 2010 | pmid = 20807448 | pmc = 2942821 | doi = 10.1186/1757-1146-3-18 | doi-access = free }}</ref>

A combination of plantar fasciitis stretching and the use of botulinum toxin showed an increase in improvement and functionability in patients.<ref>{{Cite journal |last1=Elizondo-Rodriguez |first1=Jorge |last2=Araujo-Lopez |first2=Yariel |last3=Moreno-Gonzalez |first3=J. Alberto |last4=Cardenas-Estrada |first4=Eloy |last5=Mendoza-Lemus |first5=Oscar |last6=Acosta-Olivo |first6=Carlos |date=January 2013 |title=A Comparison of Botulinum Toxin A and Intralesional Steroids for the Treatment of Plantar Fasciitis: A Randomized, Double-Blinded Study |url=http://journals.sagepub.com/doi/10.1177/1071100712460215 |journal=Foot & Ankle International |language=en |volume=34 |issue=1 |pages=8–14 |doi=10.1177/1071100712460215 |pmid=23386757 |issn=1071-1007|url-access=subscription }}</ref>