Plantar Fasciitis
- TCIM
- Feb 25, 2020
- 6 min read
Approximately 2 million people a year seek treatment for Plantar Fasciitis, according to the American Academy of Orthopaedic Surgeons.
Plantar fasciitis causes a stabbing pain on the bottom of your foot on or near your heel.
This may not seem like a major problem, but just consider how much you rely on your heels throughout the day.
Every time you take a step, get up or down, or even just stand in place you are putting pressure on your heels.
Since plantar fasciitis is the most common cause of heel pain and takes 6 - 18 months to resolve, it can be a significant source of pain in a person’s life.
While there is not a miracle cure for plantar fasciitis, there are many excellent treatments.
Some therapies even cure 97% of people who utilize them.
The pain occurs most often right after you wake up.
You may also experience it during long periods of standing, when you get up after sitting for a long time, and after exercise.
Usually, activity will help it feel better for a little while, but the pain comes back.
Causes
The plantar fascia is a thick ligament that connects the heel bone to the front of the foot.
It supports the arch of the foot and absorbs shock when you take a step.
Overuse or injury can cause microtears and inflammation, leading to plantar fasciitis.
Over time, scar tissue forms and the problem becomes a degenerative tissue condition resulting in chronic pain.
It is important to cure plantar fasciitis because chronic heel pain may cause you to change the way you stand and walk.
This often leads to other foot, knee, hip and back problems.
Risk Factors
Although some people develop plantar fasciitis without any obvious cause, there are certain factors that make it more likely.
Intense or long-distance running
Any form of exercise that puts a lot of stress on your heel, such as ballet
Flat feet or high arches
A foot position or walking pattern that puts added stress on the plantar fascia
Being female
Being in the 40 – 60 age group
Obesity
Wearing shoes that do not adequately support your foot
Regularly wearing high-heeled shoes
Prolonged standing at work, standing on hard surfaces increases the risk
Previous ankle injury
Home Remedies
There are quite a few things that you can try at home to alleviate the pain and help your feet heal.
Rest your feet.
If you stand in one place at work, try to break up the standing with walking or sitting.
Stretch your calves, Achilles tendon, and feet. Plantar fasciitis is aggravated by tight calf and foot muscles, so try gently stretching your feet and calves a few times a day.
Massage your feet and calves. This also helps loosen them.
Ice for 15 - 20 minutes three or four times a day to reduce pain or inflammation.
Choose supportive shoes with low heels, good arch support, and plenty of cushioning. Replace worn-out shoes.
Shoe inserts can also provide cushion and support.
Avoid going barefoot, especially on hard surfaces.
Instead of walking or jogging, switch to a low-impact sport for a while. Be sure to stretch when you are done exercising.
Maintain a healthy weight.
OTC anti-inflammatory medications may help with pain and inflammation. Check with your doctor and use them sparingly, as there are side effects associated with long-term use.
Traditional Treatments
Doctors will often recommend conservative treatment, which may include rest and many of the options mentioned above.
They may also recommend physical therapy, arch supports, or night splints.
Arch supports are used to more evenly distribute the pressure on your foot and night splints stretch the arch of your foot and your calf while you sleep.
Physical therapy may include exercises to stretch, strengthen, and stabilize the lower leg muscles, plantar fascia, and Achilles tendon.
The therapist may also use massage, ultrasonography, and show you how to apply athletic tape in ways that best support your foot.
If these treatments do not work after a few months, your doctor may recommend one of the following:
Steroid injections. Cortisone shots provide temporary pain relief and an increase in function but may have a deleterious effect on the plantar fascia and increase the likelihood of longer-term problems.
Shock-wave therapy is used in chronic plantar fasciitis. This therapy uses sound waves that are directed at the injured tissue. The sound waves stimulate blood flow which promotes healing and stuns nerves to stop pain. Usually, multiple treatments are necessary.
The Tenex procedure involves inserting a needle-like probe through a small incision. Ultrasound imaging is used to view the damaged area and guide the probe. Ultrasonic energy is then used to break up scar tissue while leaving the healthy tissue alone. This procedure requires approximately three weeks for recovery.
A walking cast or boot may be suggested to give your foot an extended opportunity to rest.
Surgery is a last resort, used only with severe pain when other treatments have failed.
Unfortunately, many of these treatments do not completely relieve the pain, come with a risk of complications, and relapse is common.
Regenerative Therapies
Many doctors have begun treating plantar fasciitis with regenerative therapies.
An article in Podiatry Today recommended using multiple regenerative therapies, including Platelet-rich plasma (PRP) therapy and Stem Cell Therapy.
PRP is a regenerative therapy that is becoming increasingly common for treating this condition.
In fact, some insurance companies will now cover Platelet-Rich Plasma therapy.
PRP maximizes your body’s own healing capabilities.
When you are injured, one of the things your body does to repair itself is using platelets to release growth factors that attract healing cells, including stem cells.
PRP therapy separates your own platelets from the rest of your blood, and the concentrated platelets are injected into the site of injury.
The plantar fascia is not as vascular as other types of tissue, so they do not receive as much blood flow, limiting the amount of platelets and growth factors available.
Since PRP injects the platelets directly into the tissue, the plantar fascia receives far greater concentrations than they could even in the healthiest person.
Consequently, it stimulates healing for 24 hours and shortens recovery time.
There is a wealth of evidence that PRP therapy is safe and effective in the treatment of plantar fasciitis (1, 2, 3, 4, 5).
Multiple studies (3, 4, 5) have compared the effect of cortisone injections and PRP on pain relief and improved function for patients with plantar fasciitis.
Nearly every study found that cortisone and PRP injections offer similar levels of pain relief and increased function in the first few months, with cortisone shots initially carrying a slight advantage in pain relief.
However, cortisone injections had a high recurrence of pain after 4-6 weeks. Additionally, cortisone shots carry a risk of serious complications.
In contrast, groups treated with PRP rarely experienced a recurrence of symptoms and the few who did only experienced mild pain.
Most importantly, the patients treated with PRP continue to have excellent function and lack of pain at the 1 year and 18-month follow-ups.
If you are one of the 2 million people who will experience the pain of plantar fasciitis this year, we would be privileged to help you heal.
At Temecula Center for Integrative Medicine, our experienced, compassionate team offers an array of therapies that provide pain relief while treating the source of your pain so your body can truly be restored to health.
Jonathan Vellinga, M.D. is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
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1. Yang, W. Y., Han, Y. H., Cao, X. W., Pan, J. K., Zeng, L. F., Lin, J. T., & Liu, J. (2017). Platelet-rich plasma as a treatment for plantar fasciitis: A meta-analysis of randomized controlled trials. Medicine, 96(44), e8475. https://doi.org/10.1097/MD.0000000000008475
2. Raymond Monto R. Platelet-rich Plasma and Plantar Fasciitis. Sports Med Arthrosc Rev. 2013; 21:220-224.
3. Patil, Dr & Chanchpara, Dr & Gunaki, Dr & Gaonkar, Dr & Gaonkar, Dr & Solanki, Dr & Alwani, Dr & Durgawale, Pratik. (2017). Platelet rich plasma for plantar fasciitis: Is it a hype???. International Journal of Orthopaedics Sciences. 3. 226-230. 10.22271/ortho.2017.v3.i2d.33.
4. Shetty, Sunil H. et al. (2018). Platelet-Rich Plasma Has Better Long-Term Results Than Corticosteroids or Placebo for Chronic Plantar Fasciitis: Randomized Control Trial. The Journal of Foot and Ankle Surgery, Volume 58, Issue 1, 42 – 46. https://doi.org/10.1053/j.jfas.2018.07.006
5. Aziza Sayed Omar, Maha Emad Ibrahim, Amal Sayed Ahmed, Mahmoud Said. Local injection of autologous platelet-rich plasma and corticosteroid in treatment of lateral epicondylitis and plantar fasciitis: Randomized clinical trial. The Egyptian Rheumatologist. 2012; 34:43- 49.
