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How is Plantar Fasciitis Treated?


Plantar fasciitis results from collagen breakdown of the plantar fascia at the heel bone and surrounding structures (1). It is one of the most common causes of heel pain. It is caused by inflammation of the plantar fascia - a strong sheet of tissue that extends from the heel of the foot and spreads out to connect the toes (12). The plantar fascia helps to maintain the physiological biomechanics of the foot.

Symptoms

The condition features in various ways in different individuals. One of the most common symptoms of Plantar Fasciitis is a stabbing pain close to your heel while taking your first steps in the morning. This type of pain usually reduces after you move around. Although, it worsens again on prolonged walking and standing (12). It is also common to have tenderness around the medial side of the heel. It is also possible to experience reduced ability to bend the foot upwards at the ankle due to pain and tightness of the Achilles tendon associated with the condition. It’s not uncommon to notice a limp or toe-walking due to avoidance of pain. Pain associated with plantar fasciitis usually worsens with a barefoot walk on hard surfaces (11).

Plantar Fasciitis

Causes

The plantar fascia supports the curvature of the foot and takes in a lot of shocks when standing and walking. The causes of plantar fasciitis have not been properly established scientifically. However, one of the most common theories is the constant stress placed on the tissue as it receives this shock causes small tears in the fascia. These persistent tears could result in irritation and inflammation of the tissue (12).

Risk Factors

While the causes of plantar fasciitis have not been fully established, surveys have shown that some have a predisposition to plantar fasciitis. The following risk factors have been identified:

− Age between 40 and 60 years old.
− Flat feet - this alters the normal distribution of body weight and places more tension on the plantar fascia.
− Those that constantly perform activities that put a lot of tension on the plantar fascia e.g., prolonged standing, walking, running, and dancing. Factory workers, athletes, ballet dancers, teachers, etc. fall into this category.
− Obesity - means extra weight being placed on the plantar fascia.
− Improper shoe fit - also causes the imbalanced distribution of body weight and puts more stress on the plantar fascia.
− Diabetes Mellitus - Diabetes Mellitus and other metabolic condition reduces the healing capabilities of the fascia.
− Leg length discrepancy - also causes the imbalanced distribution of body weight and puts more stress on the plantar fascia (1).

Complications

When left untreated, the pain associated with plantar fasciitis could get so severe to the extent of impeding your normal activities. The pain can also alter your walking pattern. Prolonged alteration of the normal gait pattern could result in more serious problems such as the back, knee, and hip problems.

Diagnosis and Examination

Plantar Fasciitis can be self-diagnosed. However, if you report to the hospital or clinic, your doctor, physiotherapist, or podiatrist will The clinical examination will consider your medical history, the kind of physical activity you do, the pattern of your pain, and all other signs and symptoms (4). Your doctor might request imaging investigations such as diagnostic ultrasound, MRI, and most commonly - radiographs.

Management of Plantar Fasciitis

Plantar Fasciitis accounts for up to 13% of all foot symptoms that needs professional medical attention. In one of every three cases of plantar fasciitis, both feet are affected (2). Plantar Heel Pain has affected up to 15% population. About 90% of its occurrence can be managed successfully using only conservative measures (3). In the United States of America alone, plantar fasciitis accounts for up to 2 million visits every year, also accounting for about 40% of visits to podiatric clinics (4). It is the most common podiatric condition managed in physiotherapy clinics. The symptoms of plantar fasciitis could last up to 6 months in some cases.

 

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The treatment of plantar fasciitis must put into consideration the previously mentioned risk factors. If the particular factor responsible is identified, efforts must be made to eliminate or reduce the factor and/or its effects. For example, improperly fit shoes must be corrected, and weight reduction programs must be incorporated in the case of obesity. Similar efforts would have to be made in the case of other factors.

A. Conservative Treatment

The following are other conservative measures (11) used in managing plantar fasciitis:

− Heel pads can be used to cushion the weight-bearing stress on the heel.
− Rest must be taken from inciting activities such as prolonged walking, standing, running, and dancing.
− Diabetics Mellitus and other related metabolic disorders must be treated by professional medical professionals.
− Cryotherapy (Ice) and topical analgesics can be applied after plantar fascia stressing physical activities to help reduce inflammation and pain.
− Deep effleurage massage of the foot especially at the insertion of the plantar fascia helps to reduce the pain and speed up healing. However, this should be avoided in the initial phase (2-3 days) as it could cause more injury and worsen the pain.
− Shoe inserts and other orthotic devices may be applied on prescription, especially in cases of flat foot and other altered biomechanics of the foot.
− Stretching of the plantar fascia helps with pain reduction and conditioning of the plantar fascia.
− Physical Therapy - Your physical therapist can help in setting up a treatment plan that includes stretching and strengthening exercises (7). A physical therapist also uses other modalities like orthotics prescription (e.g. night splints (8)), therapeutic ultrasound, acetic acid iontophoresis (9), Kinesio-taping (10), joint mobilization, and manipulation to treat plantar fasciitis.

B. Invasive Treatments

Asides from conservative measures, more technical invasive treatments are used by trained healthcare professionals in managing plantar fasciitis in severe cases that do not respond to conservative treatments. They include but are not limited to the following (11):

− Extracorporeal Shock-wave Therapy (5)
− Dex Prolotherapy
− Botulinum Toxin
− Steroid Injections
− Autologous Platelet-Rich Plasma
− Surgery (6)

Note that all these invasive treatment methods are usually combined with conservative modalities, and they must be applied by trained medical professionals. Highly invasive treatment such as surgery should only be considered after the failure of all other conservative measures and less-invasive treatment methods (2).

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REFERENCES

1. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc.2003;93(3):234–7.
2. Buchanan BK, Kushner D. Plantar fasciitis. https://www.ncbi.nlm.nih.gov/
3. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85-A(5):872–7
4. 2002 Podiatric Practice Survey. Statistical results. J Am Podiatr Med Assoc. 2003;93(1):67–86. http://www.ncbi.nlm.nih.gov
5. Rhim HC, Kwon J, Park J, Borg-Stein J, Tenforde AS. A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis. Life. 2021 Dec; 11(12):1287. https://www.ncbi.nlm.nih.gov/
6. https://www.physio-pedia.com/
7. Rathleff, M.S., Mølgaard, C.M., Fredberg, U., Kaalund, S., Andersen, K.B., Jensen, T.T., Aaskov, S. and Olesen, J.L., 2015. High‐load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12‐month follow‐up. Scandinavian journal of medicine & science in sports, 25(3). (level of evidence: 1b)
8. Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician. 2005 Dec 1;72(11):2237-42.
9. Osborne HR, Allison GT. Treatment of plantar fasciitis by LowDye taping and iontophoresis: short term results of a double blinded, randomised, placebo controlled clinical trial of dexamethasone and acetic acid. Br J Sports Med. 2006 Jun;40(6):545-9; discussion 549. Epub 2006 Feb 17.
10. Lori. A. Bolgla – Terry R. Malone, Plantar fasciitis and the Windlass mechanism, Journal of Athletic Training. 2004 (Jan- Mar); 39(1): 77-82
11. https://www.physio-pedia.com/index.php?title=Plantar_Fasciitis&redirect=no
12. https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846


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