what causes Plantar fasciitis and how to find treatment options that work for you

If you’ve ever experienced plantar fasciopathy (aka plantar fasciitis), you know how excruciating and debilitating it can be. 1 in 10 people will suffer from it at some stage in their life and it occurs in 25% of all foot injuries related to running. It has been estimated to account for 11-15% of all foot problems in adults.

The plantar fascia is a thick, web-like ligament that connects the heel to the forefoot. It acts as a shock absorber and supports the arch of the foot. Plantar fasciopathy is a chronic degenerative condition of the plantar fascia and is characterised by pain localised at the heel of the foot with the pain getting worse with activity. It is described as throbbing, aching or stabbing pain that can radiate along the plantar fascia to the ball of the foot.

 
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Symptoms are:

  • Instant heel or mid foot pain when standing that usually stops immediately when the foot is no longer weight bearing

  • Pain is rarely experienced in a unloaded resting state

  • Pain may improve with repeated weight loading (the ‘warm-up’ phenomenon)

  • Pain often increases 24-48 hours after excessive loading activities

Even though 90% of the cases resolve by themselves within 10 months of onset, the remaining unlucky 10% will experience chronic pain, which is more challenging to resolve.

 

Cause

Several factors such as excessive body weight, prolonged weight bearing and decreased ankle range of motion play a role in the development of the condition. When the plantar fascia is damaged, inflammation can occur and this may result in the development of scar tissue, which thickens the tendon and makes it less flexible.

 

Treatment

There are various treatment options for plantar fasciopathy with surgical treatment considered the last-line intervention due to serious injury risks and postoperative complications (2).

 

Conservative management

Conservative management is the first line of treatment and is normally able to resolve approximately 90% of cases.

  • Rest of approximately 2 weeks while avoiding total bed rest

  • Stretching

  • Taping to reduce pain

  • Minimise standing and walking time

  • Cryotherapy (ice) to reduce pain (rolling a frozen water bottle on the sole of the foot for 10-20 minutes, 2-4 times per day)

 

Minimally Invasive Management

While there a many treatment options like low level laser therapy, platelet-rich plasma injection, prolotherapy or cortisone injections, most of these have poor long-term effects, and can be quite painful.

In our experience one of the best treatment options for plantar fasciopathy is shock wave therapy, which can provide immediate symptom relief, and has no adverse events related to the therapy. It is also a relatively inexpensive treatment compared to the alternatives.

It can be quit daunting and confusing to find the right treatment option that works for you since there are so many non-invasive as well as invasive treatments available. Please remember that studies show that combination therapy (treatment involving two or more treatment modalities) tend to yield better outcomes compared to stand-alone treatments. That means you may want to opt for a few therapies that work synergistically, rather then just put all your eggs in one basket with one therapy. Just be sure that the therapies meet your requirements and expectations.

As always, if you have any questions feel free to contact us any time and we will be happy to discuss.

In good health,

Adam and the Back to Function Team


References:

1.     Hasegawa, M., Urits, I., Orhurhu, V., Orhurhu, M. S., Brinkman, J., Giacomazzi, S., ... & Viswanath, O. (2020). Current concepts of minimally invasive treatment options for plantar fasciitis: A comprehensive review. Current Pain and Headache Reports, 24(9), 1-11.

2.     Sun, J., Gao, F., Wang, Y., Sun, W., Jiang, B., & Li, Z. (2017). Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: A meta-analysis of RCTs. Medicine, 96(15)

3.     Rompe JD. Plantar fasciopathy. Sports Med Arthrosc Rev. 2009;17(2):100–4

4.     Covey CJ, Mulder MD. Plantar fasciitis: how best to treat? J Fam Pract. 2013;62:466–71.

5.     Clement DBT. A survey of overuse running injuries. PhysSports Med. 1981; 47: 9-58.

6.     Podolsky, R., & Kalichman, L. (2015). Taping for plantar fasciitis. Journal of back and musculoskeletal rehabilitation, 28(1), 1-6.

7.     Radford JA, Landrof KB, Buchibender R, Cook C. Effective-ness of low-dye taping for the short-term treatment of plantarheel pain: A randomised trial. BMC Musculoskelet Disord.2006; 7: 64.

8.     Pollack Y, Shashua A, Kalichman L. Manual therapy for plantar heel pain. Foot (Edinb). 2018;34:11–6 This manuscript shows in a review examining randomized controlled trials the role of manual therapy for plantar heel pain with conclusion that soft tissue mobilization is an effective modality for treating plantar heel pain.

9.     Ogden, J. A., Alvarez, R., Levitt, R., Cross, G. L., & Marlow, M. (2001). Shock wave therapy for chronic proximal plantar fasciitis. Clinical Orthopaedics and Related Research®, 387, 47-59.

10.  https://www.ems-dolorclast.com/03-dolorclastr-radial-shock-waves

11.  Lai TW, Ma HL, Lee MS, Chen PM, Ku MC. Ultrasonography and clinical outcome comparison of extracorporeal shock wave therapy and corticosteroid injections for chronic plantar fasciitis: a randomized controlled trial. J Musculoskelet Neuronal Interact. 2018;18:47–54.

12.  Armagan Alpturker, K., Cerrahoglu, A. B. L., & Orguc, I. S. (2020). Evaluation Effects of Laser Therapy and Extracorporeal Shock Wave Therapy with Clinical Parameters and Magnetic Resonance Imaging for Treatment of Plantar Fasciitis in Patients with Spondyloarthritis: A Randomized Controlled Trial. International Journal of Rheumatology, 2020.

13.  Wang, W., Jiang, W., Tang, C., Zhang, X., & Xiang, J. (2019). Clinical efficacy of low-level laser therapy in plantar fasciitis: A systematic review and meta-analysis. Medicine, 98(3).

14.  Kiritsi O, Tsitas K, Malliaropoulos N, et al. Ultrasonographic evaluation of plantar fasciitis after low-level laser therapy: results of a double-blind, randomized, placebo-controlled trial. Lasers Med Sci 2010;25:275–81.

15.  Cotler, H. B., Chow, R. T., Hamblin, M. R., & Carroll, J. (2015). The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain. MOJ orthopedics & rheumatology, 2(5), 00068. https://doi.org/10.15406/mojor.2015.02.00068

16.  Ordahan, B., Karahan, A. Y., & Kaydok, E. (2018). The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: a randomized clinical trial. Lasers in medical science, 33(6), 1363-1369.

17.  Mansiz-Kaplan, B., Nacir, B., Pervane-Vural, S., Duyur-Cakit, B., & Genc, H. (2020). Effect of Dextrose Prolotherapy on Pain Intensity, Disability, and Plantar Fascia Thickness in Unilateral Plantar Fasciitis: A Randomized, Controlled, Double-Blind Study. American Journal of Physical Medicine & Rehabilitation, 99(4), 318-324.

18.  Kalaci, A., Çakici, H., Hapa, O., Yanat, A. N., Dogramaci, Y., & Sevinç, T. T. (2009). Treatment of plantar fasciitis using four different local injection modalities: a randomized prospective clinical trial. Journal of the American Podiatric Medical Association, 99(2), 108-113.

19.  McMillan, A. M., Landorf, K. B., Gilheany, M. F., Bird, A. R., Morrow, A. D., & Menz, H. B. (2012). Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial. BMj, 344.

20.  Ang, T. W. A. (2015). The effectiveness of corticosteroid injection in the treatment of plantar fasciitis. Singapore medical journal, 56(8), 423.

Adam Gavine