Evidence from meta-analyses suggests significant pain relief lasts up to one year after the procedure. However, debate about the therapys efficacy has persisted. ESWT is performed with or without anesthesia though studies suggest giving anesthesia diminishes the procedures effectiveness. Complications from ESWT are rare and typically benign when present. Known complications of ESWT include the development of a mild hematoma or an ecchymosis, redness around the site of the procedure, or migraine. The third line of treatment, if shockwave therapy is not effective after around 8 weeks, is using customised foot orthoses which can offer short-term relief from pain.Affected people use further different treatments for plantar fasciitis but many have little evidence to support their use and are not adequately studied.Other conservative approaches include rest, massage, heat, ice, and calf-strengthening exercises, weight reduction in the overweight or obese, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. The use of NSAIDs to treat plantar fasciitis is common, but their use fails to resolve the pain in 20% of people.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.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.
Risk factors
Identified risk factors for plantar fasciitis include excessive running, standing on hard surfaces for prolonged periods, high arches of the feet, the presence of a leg length inequality, and flat feet. The tendency of flat feet to excessively roll inward during walking or running makes them more susceptible to plantar fasciitis. Obesity is seen in 70% of individuals who present with plantar fasciitis and is an independent risk factor.Plantar fasciitis is commonly a result of some biomechanical imbalance that causes an increased amount of tension placed along the plantar fascia.Studies consistently find a strong association between increased body mass index and plantar fasciitis in the non-athletic population. This association between weight and plantar fasciitis is not present in the athletic population. Achilles tendon tightness and inappropriate footwear have also been identified as significant risk factors. Pathophysiology
The cause of plantar fasciitis is poorly understood and appears to have several contributing factors. The plantar fascia is a thick fibrous band of connective tissue that originates from the medial tubercle and anterior aspect of the heel bone. From there, the fascia extends along the sole of the foot before inserting at the base of the toes and supports the arch of the foot.Plantar fasciitis is a non-inflammatory condition of the plantar fascia.