Managing Plantar Fasciitis - 2023 Update of Clinical Practice Guidelines

By Sharon Morris, MISCP BSc Physiotherapy, MSc Applied Biomechanics, 18th April 202 

This article aims to summarize the recent publication of updated clinical practice guidelines for the management of plantar fasciitis. The update was carried out by the American Physical Therapy Association (APTA) and published in the Journal of Orthopaedic and Sports Physical Therapy in November 2023.

The guidelines are particularly useful in supporting us as clinicians as we endeavour to use peer reviewed literature to enhance our clinical decision-making.

Incorporating a Grading System

This paper uses a grading system for the recommendation of different interventions based on the strength of the evidence. Strength of evidence is graded from A-E with A being the highest strength and E being the lowest. This grade can be seen along with each treatment modality below. It also suggests a level of obligation on us as clinicians to incorporate this information into our practice should we see fit.

Identifying the Key Learnings

Outlined below are the main take home messages from the review.

• B Foot Orthoses – Both stock foot orthoses and custom foot orthoses should be used in conjunction with other treatments and should not be used as an isolated short-term treatment for acute pain.
• A Night Splints – Night splints must or should be used for 1-3 months for management of individuals with first step pain in the morning.
• A Taping – Both elastic or rigid taping techniques must or should be used for short-term relief of plantar fasciitis.
• A Manual therapy – Clinicians must or should use manual therapy directed at joint and soft tissues in people with plantar fasciitis.
• A Stretching – Clinicians must or should use plantar fascia-specific stretching and calf stretching to improve short-term and long-term pain reduction, function, and disability.
• B Therapeutic exercise – Exercise including resistance training should be used for short-term and long-term pain reduction.
• D Electrotherapy – Manual therapy, stretching, and foot orthoses may be used instead of electrotherapeutic modalities for both short-term and long-term pain relief.
• B Dry Needling – Clinicians should use dry needling in gastrocnemius, soleus, and the plantar foot muscles for short-term and long-term pain reduction.
• A Ultrasound – Clinicians should not use ultrasound to enhance the benefits of stretching in the treatment of plantar fasciitis.
• B Low Level Laser – Clinicians should use low level laser as part of a rehabilitation program in those with both acute and chronic plantar fasciitis.
• C Phonophoresis – Clinicians may use phonophoresis with ketoprofen gel to reduce pain in individuals with heel pain/plantar fasciitis.
• E Education and counselling for weight loss – Clinicians may provide education and counselling on exercise strategies to optimise lean body mass in people with plantar fasciitis. They may also refer on for nutrition management.

A detailed assessment on the bench enables you to attain more evidence regarding the best intervention for the management of plantar fasciitis.

Reference:

Heel Pain–Plantar Fasciitis: Revision 2023: Clinical Practice Guidelines
Koc Jr, T.A., Bise, C.G., Neville, C., Carreira, D., Martin, R.L. and McDonough, C.M., 2023. Linked to the International Classification of Functioning, Disability and Health from the Academy of Orthopaedic Physical Therapy and American Academy of Sports Physical Therapy of the American Physical Therapy Association.
Journal of Orthopaedic & Sports Physical Therapy, 53(12), pp.CPG1-CPG39