This protocol is for patients with plantar fasciitis who have not achieved adequate pain relief or functional improvement after completing a structured course of first-line conservative management. When initial measures fail to meet defined clinical goals within 6 weeks, a next-line intervention is indicated.

First-Line Treatment — Failure Condition

First-line management — including patient education, activity modification, analgesia, plantar fascia and Achilles tendon stretching, antipronation taping, footwear modification, orthoses, and night splints as adjuncts — has not produced a meaningful reduction in plantar heel pain or improvement in foot and ankle functional score within 6 weeks.

Next-Step Approach (partial overview)

The next-line protocol involves a targeted physical intervention applied directly to the site of maximal tenderness at the heel. The complete eligibility criteria, procedural details, and clinical algorithm are available in the structured protocol.

Treatment Goals

VAS pain score less than 2 out of 10
Reduction in plantar fascia thickness on ultrasonography
Isoechoic or hyperechoic plantar fascia lesion on ultrasonography at 3 to 4 months post-procedure

References

Shockwave therapy is a safe and effective adjunct therapy in the treatment of plantar fasciitis. If one or more of the indications below are met, a course of shockwave therapy can be considered: I. Ultrasonography evidence for plantar fasciitis II. Not better with first-line interventions listed in "Statement 7" after 6 weeks III. Symptoms for more than 6 weeks
It is typically applied to the most tender point over the medial calcaneal tubercle.
The response to treatment can be monitored via ultrasonography between 2 to 4 weeks and 3 to 4 months post-procedure.
The patient may progressively return to lower limb impact activities or sports when any of the following criteria are met: I. At least 2 weeks after procedure II. VAS pain score less than 2 out of 10 III. Lesion is isoechoic/hyperechoic on ultrasonography IV. Patient is accustomed to walking in his/her new orthosis

DOI: 10.47102/annals-acadmedsg.2023211

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Plantar Fasciitis When First-Line Conservative Treatment Has Not Worked

References