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Miami's independent source of local news and culture. Athletes and bodybuilders have been using steroids to increase muscle mass for a long time. Many men, particularly those who participate in sports or who are interested in bodybuilding, use steroids to achieve quick results. Many steroids are sold illegally and come with a slew of negative side effects. So, what are some other safe and legitimate alternatives to steroid abuse? Are you trying to bulk up or lose weight with a legal steroid? Researchers have recently created safe, and legal steroids that can be used daily with no negative side effects.

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Steroid cream for heel pain

One study 19 found that the use of iontophoresis resulted in significant improvement after two weeks but no long-term differences at six weeks. The major disadvantages of iontophoresis are cost and time because, to be effective, it must be administered by an athletic trainer or physical therapist at least two to three times per week. Thus, iontophoresis use is probably best reserved for the treatment of elite athletes and of laborers with acute plantar fasciitis whose symptoms are preventing them from working.

Corticosteroid injections, like iontophoresis, have the greatest benefit if administered early in the course of the disease but, because of the associated risks, they are usually reserved for recalcitrant cases. A plain radiograph of the foot or calcaneus should always be obtained before injecting steroids to ensure that the cause of pain is not a tumor.

Steroids can be injected via plantar or medial approaches with or without ultrasound guidance. Studies 20 , 21 have found steroid treatments to have a success rate of 70 percent or better. Potential risks include rupture of the plantar fascia and fat pad atrophy. In cases that do not respond to any conservative treatment, surgical release of the plantar fascia may be considered. Plantar fasciotomy may be performed using open, endoscopic or radiofrequency lesioning techniques.

Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. In general, we start by correcting training errors. This usually requires relative rest, the use of ice after activities, and an evaluation of the patient's shoes and activities. Next, we try correction of biomechanical factors with a stretching and strengthening program.

If the patient still has no improvement, we consider night splints and orthotics. Finally, all other treatment options are considered. Non-steroidal anti-inflammatory medications are considered throughout the treatment course, although we explain to the patient that this medicine is being used primarily for pain control and not to treat the underlying problem. Already a member or subscriber? Log in. Mary's program and a primary care sports medicine fellowship at the Medical College of Wisconsin.

He received his medical degree from the Medical College of Wisconsin and completed his family medicine residency at the Medical College of Wisconsin St. Address correspondence to Craig C. Young, M. Wisconsin Ave. Reprints are not available from the authors. Overuse tendinosis, not tendinitis: a new paradigm for a difficult clinical problem part 1. Phys Sportsmed. Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int.

The process of athletic injury and rehabilitation. Athletic injuries and rehabilitation. Philadelphia: Saunders, —8. Reid DC. Sports injury assessment and rehabilitation. New York: Churchill Livingstone, Outcome study of subjects with insertional plantar fasciitis.

Meyer HR. The female foot. Conservative treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc. Neuromuscular properties and functional aspects of taped ankles. Am J Sports Med. The effect of exercise, prewrap, and athletic tape on the maximal active and passive ankle resistance of ankle inversion. Mechanics and pathomechanics of treatment. Clin Sports Med.

Outcome of nonsurgical treatment for plantar fasciitis. Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. Treatment of plantar fasciitis with a night splint and shoe modification consisting of a steel shank and anterior rocker bottom.

Plantar fasciitis: a prospective randomized clinical trail of the tension night splint. Clin J Sports Med. The use of night splints for treatment of recalcitrant plantar fasciitis. Foot Ankle. Pharmacologic management of pain and inflammation in athletes. McCarthy D. Nonsteroidal anti-inflammatory drug-related gastrointestinal toxicity: definitions and epidemiology. Am J Med. Treatment of plantar fasciitis by iontophoresis of 0.

A randomized, double-blind, placebo-controlled study. Ultrasound guided injection of recalcitrant plantar fasciitis. Ann Rheum Dis. Furey JG. The painful heel syndrome. J Bone Joint Surg. Complications of plantar fascia rupture associated with corticosteroid injection. Sellman JR. Plantar fascia rupture associated with corticosteroid injection. Results of surgery in athletes with plantar fasciitis. Plantar fasciotomy for intractable plantar fasciitis: clinical results and biomechanical evaluation.

Percutaneous plantar fasciotomy: a minimally invasive procedure for recalcitrant plantar fasciitis. J Foot Ankle Surg. Early clinical results of the use of radiofrequency lesioning in the treatment of plantar fasciitis. Guest editors of the series are Linda N. Meurer, M. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Previous: Diary from a Week in Practice. Feb 1, Issue. Treatment of Plantar Fasciitis. Am Fam Physician. Abstract Treatment References. Article Sections Abstract Treatment References.

Stair stretch. Slant board. Dynamic stretching with a oz can. Cross-friction massage above the plantar fascia. Towel stretching. An example of a commercially produced night splint. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access: See My Options close.

Best Value! To see the full article, log in or purchase access. More in Pubmed Citation Related Articles. Email Alerts Don't miss a single issue. Sign up for the free AFP email table of contents. Navigate this Article.

Neurologic causes entrapment syndromes. Radiating burning pain, numbness and tingling, especially at night. Diffuse symptoms over plantar surface. Medial and plantar heel symptoms. Burning pain in heel pad area. Either BTX-A was injected into the feet of the therapy group or saline into the sham group.

In the case of patients with bilateral plantar fasciitis, saline was injected into one foot and BTX-A in the other. The authors showed that the BTX-A groups had statistically significant improvements at 3 and 8 weeks in all variables tested Maryland foot score, pain visual analog scale, pressure algometry response, and pain relief visual analog scale. Crawford et al. There was no statistically significant difference in pain levels when prednisolone was given with tibial block or when anesthetic was given.

There was a statistically significant decrease in pain levels according to visual analog scales in both groups of patients receiving steroid after 1 month; however, after 3 months there was no statistical significant difference. Hence, Crawford et al. Gudeman assessed the efficacy of steroid iontophoresis in 40 feet 37 subjects.

Feet were divided equally into a group that received phosphate buffered solution iontophoresis and one that received dexamethasone iontophoresis. The treatments lasted for 2 weeks during which each foot received six iontophereses. The Maryland foot score was used to analyze the groups. The active group showed significantly greater improvement immediately after treatment. However, both groups showed positive results at 1 month follow up.

Ultimately, Gudeman et al. As evidenced above, multiple modes of therapy can lead to pain reduction in plantar fasciitis. When more conservative management is unsuccessful, steroid injection is a preferred option [ 28 — 30 ]. Although steroid injection is the mainstay for the management of many hyper inflammatory disorders, there is little known about steroid affect at the cellular level and, consequently, little about the etiology of the risks of connective tissue rupture after the same [ 31 ].

Cystic spaces and collagen necrosis were appreciated in their steroid group. This result continued through to 7 days. However, at 2 and 4 weeks following injection, these cystic spaces were replaced by an eosinophillic staining material and fibroblast proliferation was noted. Disordered collagen deposition was appreciated under scanning electron microscope. In addition, the failing strength returned to that of the control subjects. By 6 weeks, full biomechanical integrity was reestablished as evidenced by reorganization of collagen into parallel fibers.

Hence, Kennedy and Willis concluded that physiologic dosed steroid injection weakens normal tendons for up to 14 days through collagen necrosis. They also recommend limited physical activity for the 2 weeks following injection and against repeated injection [ 24 ].

Furthermore, Wong et al. Proteoglycan synthesis has a role in extracellular matrix and collagen matrix fibrillinogenesis. Wong et al. While steroid injection and iontophoresis can significantly improve foot pain in plantar fasciitis, the two methods warrant further investigation. As evidenced by Crawford and Gudeman, steroid therapy in plantar fasciitis plays a significant role in short-term therapy [ 20 , 21 ].

However, a number of complications were noted including plantar fascial rupture, plantar fat pad atrophy, lateral plantar nerve injury secondary to injection, and calcaneal osteomyelitis and in iontophoresis, burning of the underlying skin [ 21 , 34 — 39 ]. Fascial rupture and fat pad atrophy are especially serious complications as they can lead to intractable complications.

Fascial rupture interrupts the intrinsic windlass mechanism of the foot and can promote further inflammation in the surrounding tissue, thus promoting pain. In addition, plantar fat pad atrophy diminishes subcalcaneal cushioning, availing the plantar fascia to further insult and, hence, more pain. Acevedo et al. All of the ruptured patients presented with new additional symptoms including long arch pain, lateral mid foot pain, and an exam showing decreased windlass tension [ 35 ].

Treatment of plantar fasciitis rupture remains unclear. Treatment options for the rupture are open surgical repair, endoscopic repair, and nonoperative measures. Sellman and Acevedo et al. Daly et al. Because of the recent availability and facility of ultrasound US to improve needle placement accuracy and confirmatory magnetic resonance imaging MRI in clinical practice, enhanced therapeutic response rates have been reflected in some of the studies [ 29 , 30 , 35 , 41 ].

Tsai et al. In addition, following single US-guided steroid injection, fat pad atrophy, which was theorized to cause worsening pedal dynamics, was not observed [ 30 ]. Heel fat pad inflammation and degeneration may cause pain and can be misdiagnosed as plantar fasciitis [ 42 ]. Further, MRI or US can be used to make appropriate diagnoses, which is particularly important for patients with chronic polyarthritis.

Nevertheless, these complications are uncommon and preventable; rupture may occur without steroid injections [ 35 ]. Paying special attention to history and physical examination change can lend some clues to associated complications. Monitoring sudden pain loss, change of patient pain location, developing numbness, changes in plantar fascial and fat pad thickness, edema, palpable masses, asymmetric flexible hammertoe deformities of the 2nd, 3rd, and 4th toes without nerve injury, and utilizing US for follow ups and injection placement can help to alleviate negative outcomes.

Further, limiting the number and frequency of steroid injections and educating patients on reduction of aggressive physical activity during a 2-week post-injection period should be suggested [ 35 ]. Steroid therapy is a valuable adjunct to other therapy measures, including plantar fascial stretching. However, one should be cognizant that overuse of steroid injection can lead to complications.

US guidance should be utilized to improve injection target and monitor soft tissue changes, thus preventing complication. National Center for Biotechnology Information , U. Curr Rev Musculoskelet Med. Published online Sep Yusuf Ziya Tatli and Sameer Kapasi. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Oct 10; Accepted Aug This article has been cited by other articles in PMC. Abstract This article presents a review of conservative therapies for plantar fasciitis pain reduction with a discussion of steroid therapy risks.

Anatomy The plantar fascia is synonymous with the deep fascia of the sole of the foot. Open in a separate window. Mechanics of the plantar fascia Hicks described a windlass mechanism of action for the plantar fascia. Diagnosis Plantar fasciitis is a clinical diagnosis.

Method A Medline search from to the present was performed. Subject Authors Symptom duration prior to therapy Pain free time after therapy Significant improvement from baseline? Orthoses Landorf et al. Stretch DiGiovanni et al. Extracorporeal shockwave therapy Haake et al. Steroid Crawford et al.

Discussion As evidenced above, multiple modes of therapy can lead to pain reduction in plantar fasciitis. Conclusion Steroid therapy is a valuable adjunct to other therapy measures, including plantar fascial stretching. References 1. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. The pathomechanics of plantar fasciitis. Sports Med. Essential clinical anatomy.

Buchbinder R. Clinical practice. Plantar fasciitis. N Engl J Med. Hicks JH. The mechanics of the foot. The plantar aponeurosis and the arch. J Anat. Philadelphia, PA: Saunders Elsevier; J Foot Ankle Surg. Strength of recommendation taxonomy SORT : a patient-centered approach to grading evidence in the medical literature.

Am Fam Physician. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med. Effect of magnetic vs sham-magnetic insoles on plantar heel pain: a randomized controlled trial. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study.

J Bone Joint Surg. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial.

BMC Musculoskelet Disord. Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trial. Extracorporeal shock wave therapy for plantar fasciitis. A double blind randomised controlled trial. J Orthop Res. Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: a randomized controlled trial. Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy ESWT device: a North American confirmatory study.

Electrohydraulic high-energy shock-wave treatment for chronic plantar fasciitis. Treatment of pain attributed to plantar fasciitis with botulinum toxin a: a short-term, randomized, placebo-controlled, double-blind study. Am J Phys Med Rehabil.

Steroid injection for heel pain: evidence of short-term effectiveness. A randomized controlled trial. Rheumatology Oxford, England ; 38 10 —7. Treatment of plantar fasciitis by iontophoresis of 0. A randomized, double-blind, placebo-controlled study. Am J Sports Med. The efficacy of oral nonsteroidal anti-inflammatory medication NSAID in the treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study.

DOG ON STEROIDS PEEING A LOT

The thicker central portion of the plantar fascia then extends into five bands surrounding the digital tendons Fig. From Buchbinder [ 4 ]. Used with permission from NEJM. Plantar and medial views of the foot demonstrating the origin and insertion of the plantar fascia and the location of nerves in proximity to the heel.

The windlass mechanism, or bowstring effect, of the plantar fascia refers to its function in raising the arch of the foot during the push-off phase of walking. Hicks described a windlass mechanism of action for the plantar fascia. Dorsiflexion of the toes leads to a shortened effective length of the plantar fascia causing a raising of the arch.

Toe extension leads to increased arch tension with the metatarsophalangeal joint as the pivot or tethering point. Hicks [ 5 ] demonstrated this definitively with cadaveric models. When a plantar fasciotomy was performed, the cadaver would lose this windlass mechanism, thus diminishing the arch stability subsequently disallowing a more stable terminal stance and toe standing. In addition, Hicks [ 5 ] found that the breaking strain for this windlass ranged from 1.

Thus, the plantar fascia, while playing a significant role in walking stability, can readily break with a minimal increase in strain. While the exact etiology of plantar fasciitis remains unclear, it is theorized that overloading the plantar foot muscles originating at the volar calcaneus adductor hallucis, quadratus plantae, flexor digitorum brevis, and abductor digiti minimi quinti can lead to inflammation and consequent pain in the plantar fascia [ 6 ].

Hence, therapy for plantar fasciitis focuses on either reducing the muscle tightness that causes the initial injury or reducing the inflammation that worsens the injury. Plantar fasciitis is a clinical diagnosis. It is based on patient history and physical exam. Plantar fascia pain is especially evident upon dorsiflexion of the patients pedal phalanges, which further stretches the plantar fascia or windlass mechanism.

Therefore, any activity that would increase stretch of the plantar fascia, such as walking barefoot without any arch support, climbing stairs, or toe walking, can worsen the pain [ 4 , 7 ]. A Medline search from to the present was performed. Trials were included if they were randomized studies and evaluated orthoses, stretching, extracorporeal shockwave, BTX-A, or corticosteroid injection as therapies for plantar fasciitis.

Trials were excluded if they did not meet the above criteria or if they compared the efficacy of one mode of therapy to another, that is, stretching to orthoses or BTX-A to steroid therapy in plantar fasciitis. Case studies, retrospective studies, descriptive articles, and quasi-randomized studies were excluded from the review; however, these studies were included in the introduction and discussion sections Table 1.

SORT graded as per Ebell et al. Numerous treatment measures have been used for plantar fasciitis with varied clinical benefits. Nonsurgical techniques include orthoses [ 9 , 10 ], stretching [ 11 — 13 ], splinting, taping, topical medications with or without iontophoresis, oral nonsteroidal anti-inflammatory medications [ 22 ], extracorporeal shockwave therapy [ 14 — 18 ], laser, and percutaneous injections with steroid [ 20 , 21 ] or botulinum toxin type A.

Surgical options with endoscopic or open fasciotomy can be the last resort for patients with intractable plantar fasciitis [ 23 ], but are not discussed further in the article. Landorf et al. While they were able to show statistically significant results for improved function with the prefabricated and customized orthoses as compared to the sham, Landorf et al. Winemiller et al. They found that there was no statistically significant difference in improvement in subjective heel pain between different insole modes; however, there was a statistically significant improvement in both the magnetic and nonmagnetic groups in morning foot pain intensity.

DiGiovanni et al. Both Achilles stretching groups and plantar fascia stretching groups appreciated a decrease in pain upon first steps in the morning as well as increased function; however, the plantar stretchers appreciated a statistically significant improvement in activity function and first step pain as compared to the Achilles stretchers [ 11 ].

DiGiovanni further assessed the improvement of plantar fascia versus Achilles tendon stretching by directly comparing the two in a crossover study of the same patient pool with a 2-year follow up. After 2 years, the Achilles tendon patient pool was reassessed for maximum pain level and pain on first steps in the morning. While there was a significant difference between the two groups at 8 weeks, there was no statistical difference between the two at 2 years, with further improvement in pain in both groups [ 12 ].

Radford recruited 92 subjects for their study that compared calf muscle stretching with sham ultrasound to sham ultrasound alone. The study tested the short-term effectiveness of stretching. In the 14 days that the study lasted, there was no statistically significant difference between stretch and sham groups.

Radford et al. Haake et al. The patients employed in this study had tried more conservative methods of plantar fasciitis therapy without effect for approximately 6 months. The study pool either received ESWT or sham therapy. The patients were assessed after 12 weeks. Speed studied 88 patients who had plantar fasciitis for at least 3 months each.

The patients were exposed to therapeutic sessions with sham or ESWT once every month for a total of 3 months. Over the 6-month course of the study, no statistical significance was shown between sham and ESWT groups in the above categories [ 15 ]. Buchbinder et al. Kudo et al. Patients were excluded from the study if they had used other modes of therapy within 2 weeks of their treatment.

The patients were exposed to a single treatment. This study demonstrated a statistically significant improvement in first steps pain by visual analog scale at 3 months. Ogden et al. In the first phase, they formulated and finalized their protocol with 20 nonblinded patients. In the phase two trial, Ogden randomized patients to receive either ESWT and an ankle block or a mild anesthetic and nontransmitted shockwaves.

They found significant differences in investigator assessment of heel pain at 4, 8, and 12 weeks and at 12 months using a dolorimeter-based visual analog scale. Significance was also found in subjective self-assessment of morning heel pain at the same time intervals. However, in self-assessment of activity related pain, significance could be found at 4, 8, and 12 weeks, but not at 12 months.

Hence, Ogden et al. Babcock et al. Either BTX-A was injected into the feet of the therapy group or saline into the sham group. In the case of patients with bilateral plantar fasciitis, saline was injected into one foot and BTX-A in the other. The authors showed that the BTX-A groups had statistically significant improvements at 3 and 8 weeks in all variables tested Maryland foot score, pain visual analog scale, pressure algometry response, and pain relief visual analog scale.

Crawford et al. There was no statistically significant difference in pain levels when prednisolone was given with tibial block or when anesthetic was given. There was a statistically significant decrease in pain levels according to visual analog scales in both groups of patients receiving steroid after 1 month; however, after 3 months there was no statistical significant difference. Hence, Crawford et al. Gudeman assessed the efficacy of steroid iontophoresis in 40 feet 37 subjects.

Feet were divided equally into a group that received phosphate buffered solution iontophoresis and one that received dexamethasone iontophoresis. The treatments lasted for 2 weeks during which each foot received six iontophereses. The Maryland foot score was used to analyze the groups. The active group showed significantly greater improvement immediately after treatment.

However, both groups showed positive results at 1 month follow up. Ultimately, Gudeman et al. As evidenced above, multiple modes of therapy can lead to pain reduction in plantar fasciitis. When more conservative management is unsuccessful, steroid injection is a preferred option [ 28 — 30 ]. Although steroid injection is the mainstay for the management of many hyper inflammatory disorders, there is little known about steroid affect at the cellular level and, consequently, little about the etiology of the risks of connective tissue rupture after the same [ 31 ].

Cystic spaces and collagen necrosis were appreciated in their steroid group. This result continued through to 7 days. However, at 2 and 4 weeks following injection, these cystic spaces were replaced by an eosinophillic staining material and fibroblast proliferation was noted.

Disordered collagen deposition was appreciated under scanning electron microscope. In addition, the failing strength returned to that of the control subjects. By 6 weeks, full biomechanical integrity was reestablished as evidenced by reorganization of collagen into parallel fibers.

Hence, Kennedy and Willis concluded that physiologic dosed steroid injection weakens normal tendons for up to 14 days through collagen necrosis. They also recommend limited physical activity for the 2 weeks following injection and against repeated injection [ 24 ]. Furthermore, Wong et al. Proteoglycan synthesis has a role in extracellular matrix and collagen matrix fibrillinogenesis. Wong et al. While steroid injection and iontophoresis can significantly improve foot pain in plantar fasciitis, the two methods warrant further investigation.

As evidenced by Crawford and Gudeman, steroid therapy in plantar fasciitis plays a significant role in short-term therapy [ 20 , 21 ]. However, a number of complications were noted including plantar fascial rupture, plantar fat pad atrophy, lateral plantar nerve injury secondary to injection, and calcaneal osteomyelitis and in iontophoresis, burning of the underlying skin [ 21 , 34 — 39 ].

Fascial rupture and fat pad atrophy are especially serious complications as they can lead to intractable complications. Fascial rupture interrupts the intrinsic windlass mechanism of the foot and can promote further inflammation in the surrounding tissue, thus promoting pain.

In addition, plantar fat pad atrophy diminishes subcalcaneal cushioning, availing the plantar fascia to further insult and, hence, more pain. Acevedo et al. All of the ruptured patients presented with new additional symptoms including long arch pain, lateral mid foot pain, and an exam showing decreased windlass tension [ 35 ]. Treatment of plantar fasciitis rupture remains unclear.

Treatment options for the rupture are open surgical repair, endoscopic repair, and nonoperative measures. Sellman and Acevedo et al. Daly et al. Because of the recent availability and facility of ultrasound US to improve needle placement accuracy and confirmatory magnetic resonance imaging MRI in clinical practice, enhanced therapeutic response rates have been reflected in some of the studies [ 29 , 30 , 35 , 41 ].

Tsai et al. In addition, following single US-guided steroid injection, fat pad atrophy, which was theorized to cause worsening pedal dynamics, was not observed [ 30 ]. Heel fat pad inflammation and degeneration may cause pain and can be misdiagnosed as plantar fasciitis [ 42 ]. Further, MRI or US can be used to make appropriate diagnoses, which is particularly important for patients with chronic polyarthritis. Nevertheless, these complications are uncommon and preventable; rupture may occur without steroid injections [ 35 ].

Paying special attention to history and physical examination change can lend some clues to associated complications. Monitoring sudden pain loss, change of patient pain location, developing numbness, changes in plantar fascial and fat pad thickness, edema, palpable masses, asymmetric flexible hammertoe deformities of the 2nd, 3rd, and 4th toes without nerve injury, and utilizing US for follow ups and injection placement can help to alleviate negative outcomes.

Further, limiting the number and frequency of steroid injections and educating patients on reduction of aggressive physical activity during a 2-week post-injection period should be suggested [ 35 ]. Steroid therapy is a valuable adjunct to other therapy measures, including plantar fascial stretching.

However, one should be cognizant that overuse of steroid injection can lead to complications. US guidance should be utilized to improve injection target and monitor soft tissue changes, thus preventing complication. National Center for Biotechnology Information , U. Curr Rev Musculoskelet Med. Published online Sep Yusuf Ziya Tatli and Sameer Kapasi. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Ice is applied in the treatment of plantar fasciitis by ice massage, ice bath or in an ice pack.

For ice massage, the patient freezes water in a small paper or foam cup, then rubs the ice over the painful heel using a circular motion and moderate pressure for five to 10 minutes. To use an ice bath, a shallow pan is filled with water and ice, and the heel is allowed to soak for 10 to 15 minutes. Patients should use neoprene toe covers or keep the toes out of the ice water to prevent injuries associated with exposure to the cold.

Crushed ice in a plastic bag wrapped in a towel makes the best ice pack, because it can be molded to the foot and increase the contact area. A good alternative is the use of a bag of prepackaged frozen corn wrapped in a towel. Ice packs are usually used for 15 to 20 minutes. Icing is usually done after completing exercise, stretching, strengthening and after a day's work. The use of anti-inflammatory drugs in chronic inflammatory diseases is somewhat controversial.

Disadvantages of NSAIDs are many, including the risk of gastrointestinal bleeding, gastric pain and renal damage. Iontophoresis is the use of electric impulses from a low-voltage galvanic current stimulation unit to drive topical corticosteroids into soft tissue structures. One study 19 found that the use of iontophoresis resulted in significant improvement after two weeks but no long-term differences at six weeks. The major disadvantages of iontophoresis are cost and time because, to be effective, it must be administered by an athletic trainer or physical therapist at least two to three times per week.

Thus, iontophoresis use is probably best reserved for the treatment of elite athletes and of laborers with acute plantar fasciitis whose symptoms are preventing them from working. Corticosteroid injections, like iontophoresis, have the greatest benefit if administered early in the course of the disease but, because of the associated risks, they are usually reserved for recalcitrant cases.

A plain radiograph of the foot or calcaneus should always be obtained before injecting steroids to ensure that the cause of pain is not a tumor. Steroids can be injected via plantar or medial approaches with or without ultrasound guidance. Studies 20 , 21 have found steroid treatments to have a success rate of 70 percent or better. Potential risks include rupture of the plantar fascia and fat pad atrophy. In cases that do not respond to any conservative treatment, surgical release of the plantar fascia may be considered.

Plantar fasciotomy may be performed using open, endoscopic or radiofrequency lesioning techniques. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. In general, we start by correcting training errors.

This usually requires relative rest, the use of ice after activities, and an evaluation of the patient's shoes and activities. Next, we try correction of biomechanical factors with a stretching and strengthening program. If the patient still has no improvement, we consider night splints and orthotics. Finally, all other treatment options are considered. Non-steroidal anti-inflammatory medications are considered throughout the treatment course, although we explain to the patient that this medicine is being used primarily for pain control and not to treat the underlying problem.

Already a member or subscriber? Log in. Mary's program and a primary care sports medicine fellowship at the Medical College of Wisconsin. He received his medical degree from the Medical College of Wisconsin and completed his family medicine residency at the Medical College of Wisconsin St.

Address correspondence to Craig C. Young, M. Wisconsin Ave. Reprints are not available from the authors. Overuse tendinosis, not tendinitis: a new paradigm for a difficult clinical problem part 1. Phys Sportsmed. Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int. The process of athletic injury and rehabilitation. Athletic injuries and rehabilitation. Philadelphia: Saunders, —8. Reid DC. Sports injury assessment and rehabilitation.

New York: Churchill Livingstone, Outcome study of subjects with insertional plantar fasciitis. Meyer HR. The female foot. Conservative treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc. Neuromuscular properties and functional aspects of taped ankles.

Am J Sports Med. The effect of exercise, prewrap, and athletic tape on the maximal active and passive ankle resistance of ankle inversion. Mechanics and pathomechanics of treatment. Clin Sports Med. Outcome of nonsurgical treatment for plantar fasciitis. Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. Treatment of plantar fasciitis with a night splint and shoe modification consisting of a steel shank and anterior rocker bottom.

Plantar fasciitis: a prospective randomized clinical trail of the tension night splint. Clin J Sports Med. The use of night splints for treatment of recalcitrant plantar fasciitis. Foot Ankle. Pharmacologic management of pain and inflammation in athletes. McCarthy D. Nonsteroidal anti-inflammatory drug-related gastrointestinal toxicity: definitions and epidemiology. Am J Med. Treatment of plantar fasciitis by iontophoresis of 0.

A randomized, double-blind, placebo-controlled study. Ultrasound guided injection of recalcitrant plantar fasciitis. Ann Rheum Dis. Furey JG. The painful heel syndrome. J Bone Joint Surg. Complications of plantar fascia rupture associated with corticosteroid injection.

Sellman JR. Plantar fascia rupture associated with corticosteroid injection. Results of surgery in athletes with plantar fasciitis. Plantar fasciotomy for intractable plantar fasciitis: clinical results and biomechanical evaluation. Percutaneous plantar fasciotomy: a minimally invasive procedure for recalcitrant plantar fasciitis. J Foot Ankle Surg.

Early clinical results of the use of radiofrequency lesioning in the treatment of plantar fasciitis. Guest editors of the series are Linda N. Meurer, M. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.

Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Previous: Diary from a Week in Practice. Feb 1, Issue. Treatment of Plantar Fasciitis. Am Fam Physician. Abstract Treatment References. Article Sections Abstract Treatment References. Stair stretch. Slant board. Dynamic stretching with a oz can. Cross-friction massage above the plantar fascia. Towel stretching. An example of a commercially produced night splint.

Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access: See My Options close.

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For this reason, it is recommended to avoid touching your eyes or any mucous membranes after you have used such creams. Otherwise, you might experience a severe burning sensation and require medical treatment. Capsaicin cream has made the subject of numerous studies, being often appreciated for its beneficial properties.

According to a study published in Phytotherapy Research , capsaicin cream can be effectively used for the treatment of chronic soft tissue pain, improving the symptoms experienced in a significant manner. In another study, which was published in the Journal of Pain Research , capsaicin cream is presented as a highly-efficient topical preparation for pain relief. The analgesic and anti-inflammatory properties of capsaicin have been highlighted in a comparative study, which was published in African Health Sciences.

Can you just use any cream? The answer is clearly no. In many situations, foot creams are only meant to hydrate and nourish the skin, without any additional effects on the symptoms experienced by a plantar fasciitis patient. One should always on the lookout for a cream that contains active ingredients, capable of providing relief from pain, inflammation and other symptoms.

The fact that not all topical creams are efficient on plantar fasciitis symptoms has been confirmed by a study published in Complementary Therapies in Medicine. The study was meant to determine the effect of topical wheatgrass cream on the symptoms of chronic plantar fasciitis. The authors intended to determine whether topical wheatgrass cream was capable of providing the desired pain relief, as well as improving the overall foot function.

For the study in question, participants were divided into two groups, meaning the treatment group and the placebo group. The first group received the topical wheatgrass cream, while the second was administered a placebo preparation. The cream was administered two times per day, for a period of six weeks.

The participants to the study were assessed with regard to the daily first-step pain and overall foot function specific scales were used. Other assessments were made with regard to the posture of the foot, the strength of the calf muscles and the ankle dorsiflexion range. The study demonstrated that the topical wheatgrass cream was no more effective than the placebo preparation; basically, there were no significant differences between the two groups.

Final word Foot creams can be used to moderately improve the symptoms of plantar fasciitis but these must contain active ingredients, which can bring the necessary relief from the pain and inflammation experienced. It is also essential to understand that not all topical creams are effective on the symptoms of plantar fasciitis, even though they might be advertised as such.

This article was first published here on 24th July Have something to share? Drop us a line below! Top Read Of The Month. Quick Links. Media Kit. Top Categories. Inspiring Stories. Entrepreneur's Delight. Application is generally required at least times a day to be effective and pain relief lasts from 30 minutes to 4 hours.

The major discrepancies here come down to seep times, and how potent the mixture is. Other factors, like are you staying hydrated, keeping up with your massage routine or practicing yoga every day? The application is as easy as rubbing it into your heel, the affected area, and allowing it time to do its thing. One thing I found to really help was using compression socks along with these creams to really help manage the condition.

Disclaimer: I am not a doctor and this is not medical advice. I am someone who suffered from Plantar Fasciitis off and on for 3 years before my heel pain fully subsided. The following information is based off my own experience and research into what works best for plantar fasciitis. Close Menu Home. Treatment Guide. Running Shoes. Walking Shoes. Night Splints.