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Plantar Fasciitis: Bringing Your Arch Enemy to Heel

Plantar Fasciitis: Bringing Your Arch Enemy to Heel

Does walking first thing in the morning hurt your feet? That single symptom is a red flag for an extremely common foot condition called plantar fasciitis, the inflammation of the connective tissue in the sole of the foot. It often expresses itself as pain in the heel or the arch of the foot as you take your first steps in the morning. Typically this pain goes away as your feet warm up… until one day, the pain doesn’t go away. That’s usually when people will finally seek out professional help because, at this point, the ability to walk safely is threatened, and the pain can be intense! Why is plantar fasciitis so common, and what treatments are available?


What is Plantar Fasciitis?


In the condition of plantar fasciitis (pronounced “plan-tar fash-ee-EYE-tis”), the tissue that connects the heel to the toes, called fascia, develops tiny cracks that become inflamed and painful. The body attempts to heal these tiny cracks, but this makes the fascia thicker and less flexible. In the normal range of motion for walking, the tissues of the foot need the ability to flex. The damaged fascia can grow from about 3mm thick to up to 15mm (1), making it far less flexible. This lack of flexibility increases the experience of pain coming from both the fascia and the structures the fascia is attached to within the foot.


During long periods of being off your feet, such as during sleep, the fascia contracts and stiffens (1). The first steps after inactivity can then be quite painful! Walking around for a while loosens up the fascia, and the pain usually diminishes. However, if the conditions which are driving the plantar fasciitis are not addressed, eventually, the pain does not go away even after the foot gets warmed up.


Unfortunately, there’s another complicating factor. If walking is painful, people either choose to reduce their walking or, if they do walk, they’ll change the position of their feet to experience the least amount of pain. Yet both these strategies can make the condition worse.


Oh, My Aching Feet! Symptoms of Plantar Fasciitis


Since there is a lot of individuality to the biomechanics of walking (how all the muscles and bones work together), plantar fasciitis symptoms can differ from one person to the next. How advanced the condition is can also affect the frequency or severity of the symptoms. Despite that, there is agreement that sufferers may experience one or more of the following symptoms (2-4):


  • heel, arch, or sole pain, especially if: it occurs after a long period of not walking and/or first thing in the morning, the pain goes away after walking for some time, and/or the pain gets worse if you stand for a long time

  • aching or painful bones or joints in the foot

  • pain becomes worse when carrying heavy objects

  • the foot is so stiff it doesn’t “rock” from heel to toe when walking (you have to place the whole foot down flat at once)

  • a swollen heel

  • an abnormally tight Achilles tendon (connects the heel and the calf)

  • feet feel tender or ache when being rubbed

  • shooting or stabbing pain originating in the heel, arch, or sole


Why is the Risk of Plantar Fasciitis So High?


There’s a lengthy list of risk factors for plantar fasciitis, which is probably why it’s so prevalent. Close to 1 out of 10 people will experience it at some time in their lives (4). This condition is so commonplace that if you have any heel pain, it is statistically more likely to be from plantar fasciitis than anything else (5). Below is a partial list of factors that can contribute to developing plantar fasciitis or increase the risk (3, 4):


  • being a runner or athlete (overuse of the feet)

  • frequent standing or squatting (especially squatting with all weight resting on the toes and upper foot)

  • shoes that do not properly support the foot

  • the hips, knees, and/or ankles are out of alignment due to weight, injury, or genetics

  • having excess stress on the lower half of the body from being overweight

  • having weak ankles that rotate or shift away from balanced alignment

  • having flat feet or high arches

  • having a job that requires carrying heavy objects

  • scaling up athletic training too quickly

  • spending a lot of time on a hard surface (for example, cement or tile), especially with bare feet


What Are Some Possible Treatments?


Each person must be evaluated to rule out conditions with similar symptoms, such as heel spurs. Once a diagnosis of plantar fasciitis is made and the severity determined, appropriate treatment can be selected.


Note, it is helpful to pinpoint the underlying cause for the development of plantar fasciitis. The driver of the condition must be addressed in addition to healing the feet because if the underlying root cause is not addressed, the treatment benefits may not last long. Removing the cause of the condition, in addition to healing the feet, will be more likely to ensure a complete, permanent resolution.


There are some treatments such as exercises, stretches, special shoes or devices, and even cortisone or corticosteroid injections. However, there are many downsides to pursuing these approaches. Sometimes these strategies can ease the pain temporarily, but the direct healing of the underlying tissues is not achieved, and the problem returns. People may go through several cycles of the pain returning before realizing the underlying problem is not solved!


Two Highly Effective Treatments – PEMF and Ozone Injections


Pulsed electromagnetic frequency (PEMF) is a therapy that delivers small but repeated bursts of electromagnetic energy through the skin down to the structures below, such as muscles, bones, tendons, ligaments, and fascia. Highly studied since the 1970s, these pulsed waves have been proven to stimulate the repair of cells, increase wound healing and circulation, and reduce pain and inflammation (6, 7). Studies are continually being performed, applying this technology to many different kinds of injuries. Temecula Center for Integrative Medicine (TCIM) uses PEMF to repair disc degeneration in addition to using it for plantar fasciitis because it so consistently delivers safe and long-lasting results.


Ozone gas injection into the affected tissue is another direct therapy that aids in directly healing tissue. Using a fine needle, ozone gas can be injected directly into the tissues of the foot. As a gas, ozone has an extra oxygen molecule that, when donated, has a variety of effects on the body. In plantar fasciitis treatments, ozone gas injections highly stimulate the anti-inflammatory process, resulting in a strong benefit by greatly reducing local pain and swelling. Like PEMF, ozone also increases circulation to the area, increasing the volume of the body’s natural healing elements (nutrition, hydration) coming in contact with the wounded area. This effect lasts well beyond the treatment session. By helping heal damaged tissues both directly and indirectly, ozone greatly speeds healing time (8, 9).


Maximizing Benefits: PEMF + Ozone Injections Combined


Ozone injections increase circulation, reduce inflammation, and draw the natural healing responses of the body to the area. Meanwhile, the PEMF waves work on the tiny cracks in the fascia, helping cells in the fascia, tendons, joints, and muscles to repair. These two therapies complement each other, healing plantar fasciitis faster and more completely than either therapy alone. This is TCIM’s preferred combination of therapies for plantar fasciitis because together they are so potent and efficient. People usually receive immediate relief from pain and reap benefits beyond the treatment session by continuing to heal for days after.


Are There Any Downsides to PEMF + Ozone Injections?


While any therapy has some risks, this combined therapy rarely has a negative side effect or a downside. The safety record of both PEMF and ozone injections are very impressive. It’s even difficult to find any negative reactions in the medical and clinical literature now that the use of these technologies has been perfected. If anything, mild discomfort around the injection site of the ozone may be experienced, which recedes quickly.


However, there is one very important caveat. It is helpful to pinpoint the underlying cause or causes for the development of plantar fasciitis. The driver of the condition must be addressed in addition to healing the feet because if the underlying root cause is not addressed, even treatment as good as this combined therapy may not last long.


For example, pressure from excess weight on the feet can cause plantar fasciitis to return. People who must carry heavy objects during their job or who carry extra weight on their frame will be at risk of re-injuring themselves. There also may be a genetic or inborn condition that affects the mechanics of walking, which may increase the likelihood of re-injury. Each situation should be evaluated carefully because even in cases where the underlying cause may not be easily changed, the relief given by the therapy (even for a short time) may still be worth it.


For others, the underlying cause of plantar fasciitis may be something very easy to change, such as changing the type of shoes being worn, or wearing shoes in the first place! When the underlying cause has been addressed, combined PEMF and ozone injection therapy can heal the foot permanently and break you out of the cycle of pain.


If you have foot pain that you’ve been tolerating, please don’t put off addressing it. Don’t wait until it gets so bad that you have difficulties walking! Call Temecula Center for Integrative Medicine and have your foot pain evaluated right away. We can help you identify the driver of your foot pain and assist you in addressing the root cause (or refer you to the correct professional). If you need help losing weight to reduce the pressure on your feet, we can even help with that. TCIM is proud to provide potent, advanced therapies to help you walk pain-free and confidently.


 

Jonathan Vellinga, M.D.

Jonathan Vellinga, MD 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.

info@tcimedicine.com

951-383-4333


 

Sources:

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  2. Plantar fasciitis [Internet]. Mayo Clinic. Mayo Foundation for Medical Education and Research; 2022 [cited 2022Nov19]. Available from: https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846%C2%A0

  3. The epidemiology of Plantar fasciitis: Lower extremity review magazine [Internet]. Lower Extremity Review Magazine | Rehabilitation • Trauma • Diabetes • Biomechanics • Sports Medicine. 2011 [cited 2022Nov19]. Available from: http://lermagazine.com/article/the-epidemiology-of-plantar-fasciitis

  4. Plantar fasciitis: Symptoms, causes & treatment options [Internet]. Cleveland Clinic. [cited 2022Nov19]. Available from: https://my.clevelandclinic.org/health/diseases/14709-plantar-fasciitis

  5. Babaei-Ghazani A, Karimi N, Forogh B, Madani SP, Ebadi S, Fadavi HR, Sobhani-Eraghi A, Emami Razavi SZ, Raeissadat SA, Eftekharsadat B. Comparison of Ultrasound-Guided Local Ozone (O2-O3) Injection vs Corticosteroid Injection in the Treatment of Chronic Plantar Fasciitis: A Randomized Clinical Trial. Pain Med. 2019 Feb 1;20(2):314-322. doi: 10.1093/pm/pny066. PMID: 29868796.

  6. Strauch B, Herman C, Dabb R, Ignarro L, Pilla A. Evidence-Based Use of Pulsed Electromagnetic Field Therapy in Clinical Plastic Surgery, Aesthetic Surgery Journal, Volume 29, Issue 2, March 2009, Pages 135–143, https://doi.org/10.1016/j.asj.2009.02.001

  7. Pena-Philippides JC, Yang Y, Bragina O, Hagberg S, Nemoto E, Roitbak T. Effect of pulsed electromagnetic field (PEMF) on infarct size and inflammation after cerebral ischemia in mice. Transl Stroke Res. 2014 Aug;5(4):491-500. doi: 10.1007/s12975-014-0334-1. Epub 2014 Feb 20. PMID: 24549571.

  8. Elvis, A. M., Ekta, J. S. Ozone therapy: A clinical review. J Nat Sci Biol Med. 2011 Jan-Jun; 2(1): 66–70. doi: 10.4103/0976-9668.82319. PMID: 22470237; PMCID: PMC3312702

  9. Soares CD, Morais TML, Araújo RMFG, Meyer PF, Oliveira EAF, Silva RMV, Carreiro EM, Carreiro EP, Belloco VG, Mariz BALA, Jorge-Junior J. Effects of subcutaneous injection of ozone during wound healing in rats. Growth Factors. 2019 Apr;37(1-2):95-103. doi: 10.1080/08977194.2019.1643339. Epub 2019 Jul 24. PMID: 31339390.

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