Preferred management of recalcitrant plantar fasciitis among orthopaedic foot and ankle surgeons

Foot Ankle Int. 2012 Jun;33(6):507-12. doi: 10.3113/FAI.2012.0507.


Background: There are a number of different treatment options available for recalcitrant plantar fasciitis, with limited high-level evidence to guide nonoperative and operative treatment methods. The purpose of this study was to determine the current preferred nonoperative and operative treatment methods for recalcitrant plantar fasciitis by a group of experienced orthopaedic foot and ankle surgeons.

Methods: A hypothetical patient with recalcitrant plantar fasciitis was developed as the basis for a survey comprised of seven questions. The questions related to the surgeon's preferred treatment after 4~months of failed nonoperative management and then after 10 months of recalcitrant symptoms. The survey was sent to committee members of the American Orthopaedic Foot and Ankle Society (AOFAS).

Results: Eighty-four orthopaedic surgeons completed the survey (84 out of 116; response rate=72%). At the 4-month visit, when questioned regarding their most preferred next step in management, 37 (44%) respondents favored initiation of plantar fascia-specific stretching (PFSS), 20 (24%) supervised physical therapy, 17 (20%) night splinting, five (6%) steroid injection, three (4%) custom orthotics, and two (2%) cast or boot immobilization. With ongoing symptoms at 10~months, 62 (74%) respondents chose surgery or ECSWT (extracorporeal shock wave therapy) as their next step in management. Some form of surgery (alone or in combination) was chosen by 46 (55%) respondents. The most popular operative interventions were gastrocnemius recession (alone or in combination with another procedure) and open partial plantar fascia release with nerve decompression.

Conclusions: For shorter duration symptoms, tissue-specific stretching and conditioning methods were favored over anti-inflammatory or structural support modalities which is consistent with available high-level evidence studies. Heterogeneity of operative preferences for chronic symptoms highlighted the need for further high-quality studies.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Attitude of Health Personnel
  • Casts, Surgical
  • Chronic Disease
  • Fasciitis, Plantar / therapy*
  • Humans
  • Immobilization
  • Orthopedic Procedures / statistics & numerical data
  • Orthotic Devices
  • Physical Therapy Modalities
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Surveys and Questionnaires


  • Adrenal Cortex Hormones