ALL YOU NEED TO KNOW ABOUT PLANTARFASCIITIS

a quick summary /  All you need to know about plantarfasciitis  / what causes plantarfasciitis  / treatment options  /  orthotics 

 

It could take on average between 6-18 months to resolve plantarfasciitis symptoms and sometimes longer (6).

Numerous treatment modalities have been tried and tested over the years and include the following (5);

• RICE. Rest, ice, compression and elevation
• Heat
• Ice pack
• Non-steroidal anti-inflammatory drugs (NSAIDS)
• Heel pads
• Magnetic insole
• Night splints
• Walking cast
• Taping
• Plantar and Achilles stretching
• Ultrasound
• Steroid injection
• Foot orthotics
• Foot mobilisation therapy
• Extra-corporeal shock wave therapy
• Platelet-rich plasma injection
• Pulsed radio frequency electromagnetic field therapy
• Surgery

Unfortunately, few high-quality randomised, controlled trials have been made to support these therapies (5). However, we have treated thousands of patients suffering plantarfasciitis and will discuss the following;

• Footwear
• Stretch and strengthening exercises
• Icing versus heat packs
• Foot orthotics
• Steroid injection
• Foot mobilisation therapy
• Shockwave therapy
• Surgery

Stretching Exercises

Tight calf muscles can cause plantarfasciitis therefore it’s important to stretch the back of the calf and underneath the foot (3). This stretching as been suggested repeatedly in the literature as a successful way to relieve plantarfasciitis. (5).

However a randomised control trial actually found that stretching underneath the foot was more effective in relieving plantarfasciitis than stretching the calf muscles (1).

Foot Mobilisation Therapy

Foot mobilisation therapy is a specialist manual therapy technique which we focus on at The Foot and Leg Clinic.  It works to identify which of the many foot joints are stiff and lodged in the wrong position.  We then manually mobilise the bones of the feet to improve mobility and promote fluid production around the small joints of the foot by breaking adhesions or restrictions around these joints.  Ultimately this works to improve the joint alignment, allowing the foot and lower leg to function better.  In particular, foot mobilisation therapy can reduce the stress applied to the heel and allowing healing and pain reduction.  Some of our patients report that they are free of pain after just 1 session of foot mobilisation therapy, and this can be after years of suffering heel pain.  This is predominately an anecdotal change in symptoms during the early stages of recovery, however it proves this therapy is excellent for the treatment of plantar heel pain.

We find foot mobilisation to be the number 1, simplest and most effective treatment of heel pain of all the treatment options available at the clinic.

See here for additional information regarding foot mobilisation therapy.

Foot Orthotics

Foot Orthotics are routinely used all around the world in the treatment of plantarfasciitis.  They work to improve the posture of over pronated feet (“flat feet), supporting the longitudinal arch of the foot.  In the clinic we routinely use foot orthotics as an affective method of reducing pain associated with plantarfasciitis and to aid healing.

We prescribe custom foot orthotics and sometimes off-the-shelf orthotics to alter and improve foot position thereby altering the forces acting through the foot.  The custom foot orthotics used at the clinic are manufactured at our own workshop close by the clinic.  This way we can ensure accuracy in prescription and a speedy supply appointment.

See here for additional information regarding our Foot Orthotics.

Steroid Injection

Suggested as a form of treatment if other conservative treatment options have failed to relieve symptoms associated with plantarfasciitis. It is advisable that the point of injection is as precise to the injury site as possible, as such the preferred option would be ultrasound guided injection.  This would allow the practitioner to see the site and extend of injury on the screen whilst injected, therefore they are more likely to accurately inject the correct site.

Steroid injection has been shown to significantly reduce plantar fascia thickness as early as two weeks and one month following treatment. Additionally, there is a significant correlation between decreased plantar fascia thickness and improvement in symptoms.  However, the science literature as found that these effects are short-term with the effectiveness of treatment not maintained beyond six months (2).

Shockwave Therapy

Extracorporeal Shock Wave Therapy (ESWT) is non-invasive treatment where a hand held device is applied outside the body, introducing energy to painful areas and promoting the body to heal itself.

ESWT is indicated if there is failure of other conservative modalities such as stretching exercises, casting or night splinting, and symptoms lasting for more than 6 months.  Excellent results have been found from using shockwave therapy in the treatment of plantarfasciitis and it has been suggested as a treatment option (4).

See here for additional information on how our shockwave therapy service can help you.

Surgery

If symptoms have not resolves after 12 months then surgery has been suggested as a viable option in treating plantarfasciitis.  Whilst there are more than one surgery type available, Topaz Surgery is fairly common in treating plantarfasciitis.  The surgeon would insert needles (2-3) into the plantar fascia to help break up scar tissue on the fascia.  This should then stimulate a healing response from the body, and increase blood flow and circulation to the injured fascia.

It would a good idea to perform EMG studies prior to surgery in-order to rule out a diagnosis of posterior nerve entrapment.

Literature Cited:

1. DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, et al. Tissue-specific plantar fascia stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. 2003;85-A:1270–7.
2. Fabrikant JM, Park TS. Plantar fasciitis (fasciosis) treatment outcome study: Plantar fascia thickness measured by ultrasound and correlated with patient self-reported improvement. Foot (Edinb) 2011;21:79–83.
3. McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain-plantar fasciitis: clinical practice guildelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38:A1–18.
4. Saber N, Diab H, Nassar W, Razaak HA. Ultrasound guided local steroid injection versus extracorporeal shockwave therapy in the treatment of plantar fasciitis. Alexandria J Med. 2011;48:35–42.
5. Tahririan, M.A., M.M. Mohammad,  N. Tahmasebi, and B. Siavashi. 2012. Plantarfasciitis. J Res Med Sci. pp. 799–804
6. Young CC, Rutherford DS, Neidfeldt MW. Treatment of plantar fasciitis. (477-8).Am Fam Physician. 2001;63:467–74