While the fact that 90% of plantar fasciitis cases can be resolved with conservative at-home treatment, if you’re one of the 10% whose plantar fasciitis doesn’t respond to natural remedies–and perhaps even gets worse–it can be discouraging, to say the least.
Everyone is different. And if you’ve exhausted the options for conservative treatments like rest, icing, stretching, and support from orthotic inserts over nine months to one year, it’s time to consider more advanced treatment options with your doctor.
What are your options when plantar fasciitis won’t go away, and what can you expect in terms of options, costs, and special considerations?
The good news is, there are several effective options to explore with your doctor.
Advanced Treatment Options for Plantar Fasciitis
There are many treatment options for advanced plantar fasciitis that gets worse or doesn’t respond to conservative treatments. However, take heed of separating anecdotal evidence (you’ll find an abundance!) in favor of research. The following are the most popular advanced treatments for stubborn cases of plantar fasciitis:
Ultrasound therapy essentially works by vibrating and stimulating tissues and cells. It’s relatively painless, simple, and less expensive than many other advanced therapies. However, while some people sing the praises of this advanced treatment for stubborn plantar fasciitis, the evidence of its effectiveness is meager at best.
Extracorporeal Shockwave Therapy (ESWT):
ESWT is more expensive (often close to 200 dollars per visit) and significantly more painful than standard ultrasound therapy. Several studies have concluded it seems to be effective for treating stubborn cases of plantar fasciitis; however, there by no means is a consensus among doctors or patients.
Platelet-Rich Plasma Injections:
In this therapy, your own platelet cells are centrifuged and then injected into the damaged plantar fascia. And while this therapy has become very popular among certain athletes for a variety of injuries, its effectiveness hasn’t been proven. It’s also expensive–running upwards of $300 per injection.
Cortisone, a powerful anti-inflammatory, is generated naturally by your body in response to stress. Corticosteroid injections use a synthetic version of cortisone and are injected directly into the heel. While these injections appear to have high rates of success for short-term relief (several weeks), long-term effects are unclear. The cost of one injection can range from $100 to $300; a series of three shots is the typical prescription.
Radiation therapy, often used in the treatment of cancer, has been shown to be an effective treatment for some stubborn cases of plantar fasciitis. This therapy is also on the lower end of cost, has minimal side effects and risks, is simple and non-invasive, and is not painful. The procedure similar to getting an x-ray. One 2012 study found that 80 percent of patients experienced complete pain relief following the therapy, and 64 percent were still pain-free 48 weeks later.
Intracorporeal pneumatic shock therapy (IPST):
This new therapy is similar to ESWT and applies shock waves to heel spurs. It requires local anesthesia and is less painful than ESWT. One study showed a 92% success rate in pain reduction reported by patients. It’s also less expensive than ESWT.
Numerous Surgical Options:
While surgery should be considered as a last resort for advanced disease because of its cost and potential complications, it may be a good choice if other treatment methods fail. Many types of surgery for plantar fasciitis have high success rates but require significant time off your feet, high costs, and pain.
Finding a Plantar Fasciitis Doctor
It can be a challenge to find a family doctor who is prepared to treat severe or chronic cases of plantar fasciitis. Many people who suffer from plantar fasciitis that does not respond to treatment seek the help of a podiatrist, who specializes in feet. However, not all podiatrists are alike. Some may lean more heavily on surgical options, while others take a more graduated approach. Search medical forums like ratemds.com and patient forums dedicated specifically to plantar fasciitis for recommendations and insight before you make a commitment to a particular doctor. If you find that you’re not aligning with a particular doctor, don’t be afraid to make a change. It might be a hassle, but your peace of mind and healing are worth it!
Managing Chronic Heel Pain
Many advanced treatment options for plantar fasciitis are administered over a period of time. During treatment, it’s important to have go-to options for pain management that help you find relief and stay positive. Working with your doctor, you may find that the following pain-management tools are helpful while you undergo advanced treatment for plantar fasciitis:
- RICE: Conservative methods used to treat plantar fasciitis can still be used as tools to manage pain, even while exploring more advanced treatment options. RICE, or rest, icing, compression, and elevation will help improve circulation, numb pain, and reduce inflammation.
- Orthotic Inserts: Orthotics made especially for plantar fasciitis not only provide cushioning but lift the heel and arch so that heel spurs (a major source of pain in many cases of plantar fasciitis) don’t dig into the heel.
- Night Splints: Using a night splint, which gently and comfortably stretches the heel and arch while you sleep, can help take the bite out of morning pain.
- Self-Massage: Applying gentle pressure while rolling a mobility ball or golf ball beneath your heel and arch can stimulate blood flow and reduce pain.
- Stretching: A variety of stretches for the heel and foot can improve flexibility and strength in the arch, as well as reducing morning pain.
- Over-the-Counter Anti-Inflammatory Drugs: Anti-inflammatories like ibuprofen can reduce inflammation and pain as needed. Just be sure to follow dosing instructions and consult with your doctor when taking these drugs long-term, since overuse can harm the lining of your stomach.
While conservative treatments for plantar fasciitis are appealing because of their effectiveness and low cost, there are cases in which advanced treatments and even surgery may be the right choice for you. By understanding your options, working with a trusted doctor to create a plan, and using pain-management techniques, you can look forward to a brighter future that doesn’t revolve around foot and heel pain.