Plantar Fasciitis Easier to Treat Than Many People Think

Most health care providers will tell you that certain conditions will show up in their office in clusters. Lately, I've been seeing a whole slew of plantar fasciitis cases. This usually presents as acute and severe heel pain that is particularly troublesome when walking or during the first few steps after getting out of bed in the morning. Sometimes a heel spur will appear on the x-ray. Many of my patients suffering with this condition are distance runners and tri-athletes who are currently entering their "off" season and are feeling the cumulative effects of their intense training. Other patients are comparatively less active but still suffer the same.

Plantar fasciitis is an acute inflammation, strain, or even partial tearing of the plantar fascia which is a ligamentous structure that supports the longitudinal arch of the foot. Repetitive stress such as running or prolonged standing are common causes. However, if there are biomechanical distortions in the lower extremity, such as foot pronation (flat feet), or misalignments of the spine and pelvis, physical stresses along the entire kinetic chain can manifest as a weak spot at the attachments of the fascia. This will develop into acute inflammation or partial tearing simply from normal daily activities. Once set in, though, plantar fasciitis can be very painful and disabling.

In a comprehensive review of the literature published in the Journal of the American Academy of Family Physicians in 2005, standard medical and podiatric treatments for plantar fasciitis showed pretty poor outcomes for the most part. In many cases full resolution of the problem is reported to take several years. Of course, this can vary depending on who the patient sees for treatment. In my office full resolution usually takes 4-6 weeks with most of the work being done by the patient at home. Orthopedists and podiatrists tend to rely on anti-inflammatories, plantar fasaciitis night splints and possibly some home stretches. Sometimes, unfortunately, surgery would be recommended.

The anti-inflammatories will often provide some immediate relief but it's usually temporary. The night splints can help stretch the fascia and help the cases where there is significant pain during the first few steps after getting out of bed in the morning. The home stretches really are not that effective unless the biomechanical distortions outlined above are addressed. Unfortunately, while these techniques can temporarily provide some comfort, they rarely eliminate the condition altogether and the patient often becomes discouraged. As a result the condition can linger for many years and patients will suffer needlessly. Surgery, however, is not at all indicated according to a review of the evidence. I could not find any studies that outline the vast amount of money spent (wasted?) on these standard treatments that are shown to be less than effective.

For years chiropractors have experienced significant success treating plantar fasciitis. Probably because they address the underlying biomechanical issues in the foot and pelvis I've talked about. This combined protocol is, unfortunately, not included in the literature review published in the Journal of the American Academy of Family Physicians. If it were, I figure we'd be at the top of their list of recommendations. It stands to reason that if the misalignment in the foot or pelvis remains untreated the problems will just keep coming back. This may be why standard orthopedic and podiatric treatments that focus merely on controlling the pain are only marginally effective.

Recently, I've re-formatted my approach when treating plantar fasciitis and I'm getting even better results. I still do all the wonderful chiropractic analysis and adjust whatever biomechanical issues in the spine, pelvis or foot that I find. However, I recently have added a deep, patient assisted, soft tissue treatment called Active Release Technique to my protocols for plantar fasciiitis. The concept is to lengthen the tissue while maintaining a light pressure or tension along the length of the fibers. This will break down adhesions in the fascia, ligaments, tendons or even nerve sheaths. Essentially the injured area will become more elastic, less pain sensitive and even stronger in just a few treatments. Sort of like a triage for the injured tissue itself. Once the patient is sub-acute, typically in 2-3 weeks, I will install a home stretching and strengthening program that will usually eliminate the need for extended numbers of visits or physical therapy.

The home program is pretty simple and starts with a frozen bottle of water to roll the foot on when it's very sore. Once the patient is walking comfortably (usually within 2-3 weeks) I have them, while seated, roll the foot over a golf ball to break up trigger points along the fascia as it's healing. You want to constantly remodel the tissue as it heals.Also, trying to control the golf ball without letting it slip away is a great way to begin a balancing exercise to strengthen the injured area and entire underneath of the foot. There are additional exercises that really need to be reviewed one on one with a chiropractor or physical therapist that can maximize the healing. In some cases where the foot is woefully pronated customized orthotic shoe inserts are needed to reduce the frequency and severity of future episodes. In my opinion both Footlevers and Ortho-Rite make superior products that really are not very expensive.

Using these combined methods seems to provide a faster, easier, safer and more effective way to deal with plantar fasciitis. In the long run it's also quite a bit less expensive than the standard orthopedic, podiatric and physical therapy modalities.