Treatments For Plantar Fasciitis Foot Pain
Heel and foot pain is a common thing, especially if you are working in an environment that requires you to be standing for long periods of time. When you're on your feet for extended amounts of time, it's natural to get that aching feeling. If you're feet are aching, you may contribute it to nothing more than standing or running. However, if you're feeling heel and foot pain first thing when you wake up and your work doesn't require that much standing, you could be suffering from plantar fasciitis.
Plantar fasciitis is one of the most common causes for orthopedic complaints as is causes pain to the bottom of the heel. The plantar fascia is a thin ligaments that attaches to your heel, extends through the arch or your foot, and branches out all the way to your toes. This ligament supports your arch and helps you to walk and run. The plantar fascia ligament absorbs the brunt of impact as you walk or run and experiences a lot of wear and tear during your normal daily activities. Since this ligament acts as a shock absorber, too much pressure to your feet can cause the plantar fascia to become damaged which can lead to tears within the ligament. When the plantar fascia becomes damaged, it becomes inflamed and that inflammation causes stiffness and pain in the heel.
The main symptom of plantar fasciitis is the complaint of intense heel pain and stiffness. Some people may feel pain in the mid foot toward the arch, but the pain from plantar fasciitis is usually contained to the bottom of the heel. The pain usually develops gradually over time, but can sometimes become suddenly apparent. While plantar fasciitis normally only affects one foot, it can affect both feet.
Those experiencing plantar fasciitis feel a sharp, stabbing pain on the bottom of the foot that decreases after a few minutes, but may return after standing or sitting for long periods of time. The pain can disappear during activity, but return afterwards. Since plantar fasciitis is aggravated by standing and walking, it can often affect people for 3 to 9 months. Many jobs require hours of standing, and anyone who is relatively active can experience a slow recovery because of everyday walking and standing. Those in professions that require continuous standing can have a tendency toward long-term problems.
People who are overweight or are obese are at a great risk for suffering from plantar fasciitis. The extra weight increases the pressure on the plantar fascia ligament, leading to plantar fasciitis. Women who are pregnant can experience bouts of plantar fasciitis, especially toward the end of their pregnancy. Long-distance runners are also susceptible to plantar fasciitis. People who have very active lifestyles or jobs where they are on their feet for extended periods of time without proper rest are also at risk for plantar fasciitis. People between the ages of 40 and 70 are at the highest risk for plantar fasciitis because the natural aging process causes the plantar fascia ligament to lose some of it's elasticity, leaving the ligament open for more damage. While plantar fasciitis affects both men and women, it is more common in women.
Other foot conditions, like high arches or flat feet, can also lead to plantar fasciitis. Plantar fasciitis pain can also be caused by a tight Achilles' tendon which is the tendon that attaches your calf to your heel. Wearing ill-fitting shoes and shoes with poor arch support can lead to plantar fasciitis. Along with plantar fasciitis, calcium build-ups, or bone spurs, can be deposited in your heel bone and every time you walk, these protrusions are pushed into the pad of your heel which causes further pain with every step.
When you visit our Gilbert office, we will perform a physical exam to check for tenderness and to locate the place of pain. We want to make sure that you are not suffering from a different foot problem. You will be asked to flex your foot while pressure is put on the plantar fascia in order to see if your pain gets worse as you flex and better when you point your toe. We will also evaluate the strength of your muscles and the health of your nerves by checking:
An X-ray or MRI may be needed in order to eliminate other possibilities that may be causing your foot pain.
Treatment for plantar fasciitis is directed at decreasing the chronic inflammation of the plantar fascia, stretching tight muscles, and encouraging proper healing of the fascia. Initially you will want to start with home treatments which includes lots of rest and ice therapy. By decreasing the activity and pounding forces to the soft tissue muscles, tendons, and ligaments, the tissue is given a chance to heal and recover. Many people think plantar fasciitis should heal within a few days, but they often wait too long before seeking treatment or reducing their activity, which results in severe damage to the plantar fasciitis that requires weeks to heal. Changing footwear is very beneficial to anybody experiencing foot pain. Wearing more supportive shoes that absorb the forces while walking, standing, and running remove those forces from the plantar fascia, which means the tissue is not exposed to as much trauma and has a better chance to heal and recover. You can also use night splints and orthotics to decrease stress and support the arch and fascia. Over the counter nonsteroidal anti inflammatory drugs (NSAIDs), as recommended by your doctor, can help reduce pain and inflammation, as well.
Common home self treatment products we recommend include roller balls, golf balls, prostretch, ice packs, and the strassburg sock. Patients with severe plantar fasciitis should definitely use these products at home to decrease pain and enhance healing.
If home treatments don't work in reducing your pain, the next step is active treatment which involves physiotherapy to decrease inflammation of the plantar fascia through electrical stimulation and ultrasound. Stretching of the calves and hamstrings will also reduce stress and improve your walking mechanics: another key component of therapy. Proper proprioceptive and foot strengthening exercises prescribed by your healthcare provider will further strengthen your foot and decrease stress on the plantar fascia.
Specific balance exercises can be given to increase foot strength and endurance. Often times patients have weakness in their ability to stand on one foot with their eyes closed while maintaining their balance. This lack of proprioceptive ability results in excessive strain on the lower leg and foot during running. Properly strengthening these muscles helps relieve stress on the tissues and ultimately allows the fascia to heal. Exercises can be performed on the ground, unstable surface such as a BOSU ball, foam, or vibration plate. The more difficult and challenging the surface the more the body is challenged and will improve.
However, it can be difficult to successfully treat plantar fasciitis because the cycles of inflammation and healing need to be taken into account. Cycles of stress, rest, stress, and rest often produces improper scar tissue formation on the fascia. Scar tissue is essentially a temporary patch until the injured area can heal correctly. In many cases, however, the foot often ends up with patches of scar tissue that become injured daily with standing and therefore the foot never heals correctly. A very successful treatment that aims to break up the scar tissue and allows the plantar fascia to heal correctly is the Graston Technique.
Graston technique is one of most effective treatments at improving plantar fasciitis. It can be used on all of the lower leg muscles and the bottom of the foot, along the plantar fascia. Graston technique utilizes stainless steel instruments specifically designed to break up scar tissue by sheer force. When the tools slide along the skin they help pull one layer of tissue past another. The scar tissue that has developed from the micro tearing of the fascia is pulled apart, which triggers the body's healing mechanisms to come in and repair the fibers. Oftentimes scar tissue has developed along the plantar fascia from years of standing, walking, and running. Graston technique helps break up the scar tissue throughout the fascia. Treatment from the Graston Technique increases the speed of healing and quickly reduces the sharp pain.
Class IV cold laser or low level laser therapy is an excellent treatment modality for decreasing pain and inflammation. Specific wavelengths and frequencies help shut off inflammatory cells. By stopping the production of these inflammatory markers there is less pain and inflammation around the tissue. Excessive inflammation slows down healing and makes the area more sensitive to the touch. Different wavelengths and frequencies help turn on the repair and healing processes inside cells. These wavelengths trigger the increased ATP or mitochondrial production of energy within the cells. The repairing cells then use this energy to lay down more fibers at a faster time frame. Laser is speeding up the healing and repair processes in addition to decreasing the inflammation.
Many people with plantar fasciitis have weakness in the foot and ankle stabilizer muscles. Muscle weakness and fatigue leads to foot over pronation which strains and stretches the plantar fascia. Likewise, foot and ankle weakness changes your walking gait and leads to increased pounding with each step.
Stretching and strengthening exercises progress from basic standing on one foot to dynamic and explosive exercises. More information and examples can be found at foot strengthening exercises.
Prior to Graston Technique, manual therapy, and proprioceptive exercises extracorporeal shockwave therapy was a popular treatment; which involves using waves of energy to break up scar tissue on the bottom of the foot.
Newer medical treatments involve plasma rich prolotherapy or prp to stimulate healing . By increasing platelets around a soft tissue injury, the body's healing mechanisms are stimulated. Blood is withdrawn from the patient, and the blood is separated into parts. The healing platelets are injected into the bottom of the foot.
Stem cell treatments are continuing to evolve over time. Stem cells help with soft tissue healing by enhancing healing and repair. These treatments are significantly more expensive but have not shown to be more effective than prp or conservative treatments. As therapy and treatments evolve, we might begin seeing stem cell therapy for severe cases of plantar fasciitis. Stem cell treatments are more effective in other areas of the body and with different injuries.
As with most injuries, plantar fasciitis is best treated early. The longer the injury goes untreated and the more severe it becomes, treatment will become more involved. If you are experiencing symptoms of plantar fasciitis, seek help from an experienced provider as soon as possible. Our Chandler Chiropractic & Physical Therapy clinic treats patients with a variety of muscle, tendon, joint, and ligament injuries. The clinic provides treatment for runners, tri-athletes, and weekend warriors in addition to common headache, neck, and back patients traditionally seen in Chiropractic, Physical Therapy, Massage Therapy clinics. We work with all ages and abilities of the residents in Ahwatukee, Phoenix, Tempe, Gilbert, Mesa, and Chandler AZ.