Cause and Treatment of plantar fasciitis

Why does your foot hurt?

Plantar fasciitis is a common condition which features pain the bottom of the foot which can include the heel and or the arch of the foot. It is one of the most common reasons for hell pain in the United States and affects nearly 2 million people a year. Those suffering from this painful condition often report increased pain when getting out of bed, walking or standing on their feet for long periods. Individuals presenting with plantar fasciitis often reveal additional complaints such as knee pain, hip discomfort, low back pain, neck pain or headaches and it is not uncommon to discover foot tenderness and lower leg tightness in patients presenting with other spinal complaints. 

 

Multiple tender spots and areas of pain may indicate a mechanical dysfunction that is causing stress to the foot. Decreased physical activity, computers, smart phones, prolonged sitting and increased body mass all contribute to faulty posture and gait (walking). The feet have support the body above them in addition to taking part in the motion of walking, so any undue pressure along the spine and legs will stress the bones and soft tissue of the foot. The problem with most treatments for plantar fasciitis is that they fail to look above the foot for the cause of the irritation.

Another probelm with the conventional treatment is that they didn't even name plantar fasciitis correctly!

 

 

The -itis part of plantar fasciitis is misleading. -itis is used to describe inflammation which is a process the body uses to attack foriegn substances or to break down damaged tissue followed by a period of repair. Studies have shown that plantar faciitis is a form of degeneration more than it is inflammation,  meaning that the tissue is not being repaired but rather is deteriorating.  Deterioration in the body means that the condition is worsening. 

Treating only the irritation (the fasciitis) and not identifying the cause (why it is being irritated)  may lead to unsatisfactory results. In the study Plantar Fasciitis   the authors state "the typical resolution time is anywhere from 6 to 18 months and sometimes longer" 1

                                                               6 to 18 months and sometimes longer

Many research articles state this extended period along with common treatments including:

  • Oral analgesia and non-steroidal anti-inflammatory drugs
    " the use of an NSAID may increase pain relief and decrease disability in patients with plantar fasciitis when used with a conservative treatment regimen." 2
     
  • Steroid injections
    Corticosteroid injections, although helpful in the treatment of plantar fasciitis, appear to predispose to plantar fascia rupture. 3

  • Orthotic devices
    "A 2008 Cochrane Review showed that custom orthotics may not reduce foot pain any more than sham orthotics, over-the-counter orthotics, or night splints and were not any better than stretching alone " 4

  • Extracorporeal shockwave therapy
    "The results suggest that this therapeutic modality should be considered before any surgical options, and even may be preferable to cortisone injection, which has a recognized risk of rupture of the plantar fascia and recurrence of symptoms." 5
    " patients can expect to pay between $500 and $1,800 for shock wave therapy." 6

  • Protein rich plasma
    "results indicate that treating chronic plantar fasciitis with PRP injections is safe and has the potential to reduce pain." 7
    Ranges from $500-$3000, depending upon, type of PRP used, number of injections and the condition." 8

In the article : Point-Counterpoint: Is PRP Beneficial For Chronic Plantar Fasciitis? , Dr. Patrick DeHeer states "Regardless of whether you think this an inflammatory versus a degenerative process, ignoring the biomechanical etiologies such as pronation syndrome, cavus deformity and equinus ( tight calves)  will not lead to consistent favorable outcomes."