The plantar fascia is a thick ligament that is located along the bottom of the foot. It originates from the heel bone and extends to the toes. Plantar fasciitis (acute phase) or plantar fasciosis (chronic phase) are the terms used to describe pain at the bottom of the foot when damage has occurred to this ligament. Most commonly this is caused by an overuse injury such as a new running or training program that produces repetitive micro-tears, most commonly at the origin of attachment on the inner aspect of the heel bone.
Common symptoms of plantar fasciitis
The most common symptom of plantar fasciitis is a gradual onset of pain on the bottom of the foot at the heel bone. Typically, the pain is worse when initially standing. This is termed “first-step pain” and is usually more prominent following prolonged periods of sitting or lying down. This is due to rapid stretching of the plantar fascia after prolonged periods of fascial shortening. Pain may be described as a sharp tearing sensation that diminishes after a few minutes of standing or may be expressed as a “bruised heel.” However, there is no visible discoloration. Patients tend to notice an immediate reduction of pain upon sitting or relaxing the plantar fascia ligament.
Most common contributing factors
As previously mentioned, plantar fasciitis is typically seen in patients who start a new activity program, or who experience excessive periods of standing. Individuals who start a new long-distance walking, hiking or running program are particularly susceptible to this condition. In addition, having excessively tight hamstrings and calf muscles along with poorly fitting shoes or flat feet may also contribute to plantar fasciitis.
Questions to ask yourself when considering if you have plantar fasciitis
- Do my signs and symptoms correlate with the onset of a new exercise program?
- Did my heel pain have a gradual onset over several weeks/months?
- Did I have sudden heel pain following a traumatic event? This suggests an acute injury.
- Has there been any recent change in career or daily activities that require me to stand on my feet for prolonged periods?
- Have I noticed any recent gain in body weight?
- Is there excessive heel wear on the inner aspect of my shoes?
Treatment
In most cases, the treatment of plantar fasciitis can be managed with a conservative approach. First, your physician needs to find the root cause of your injury. Once the root cause of your condition has been identified, an appropriate treatment plan can be implemented. Most conservative treatment plans may include some or all of the following: rest, ice, exercise/rehabilitation program, activity modification, self-myofascial release such as foam rolling, instrument assisted soft tissue mobilization such as Graston, myofascial release technique such as ART, and joint manipulation.
Exercise and shockwave therapy have been shown as an effective, long-term treatment.
In a study by Ugurlar et al., 2018, they compared four types of treatment on chronic plantar fasciitis, including: shockwave therapy, corticosteroid injections, prolotherapy and platelet-rich plasma.
The study included six follow-up periods at the 1-, 3-, 6-,12-, 24- and 36-month post-treatment, and found that shockwave therapy was most beneficial in the first six months after treatment concluded (Ugurlar et al., 2018). The study also found that shockwave therapy began working within two weeks of application, with success rates between 48-88% (Urgurlar et al., 2018).
As a non-invasive treatment to supplement a chiropractic program, shockwave therapy for plantar fasciitis is a great option. It can be effective for all kinds of injuries, both chronic and acute.
Shockwave therapy is also effective in treating other common conditions, like Achilles tendinopathy and lateral epicondylitis. Talk to us about treatment options for you.
If your condition doesn’t resolve or diminish within two to three weeks of conservative management, a more aggressive form of treatment should be considered. This would include an orthopedic consult to discuss corticosteroid injections or a release of the plantar fascia itself.
References
[1]Kadakia, A. R. (2010, June). Plantar Fasciitis and Bone Spurs – OrthoInfo – AAOS. Retrieved from https://orthoinfo.aaos.org/en/diseases-conditions/plantar-fasciitis-and-bone-spurs.
[2]Uğurlar, M., Sönmez, M. M., Uğurlar, Ö. Y., Adıyeke, L., Yıldırım, H., &Eren, O. T. (2018). Effectiveness of Four Different Treatment Modalities in the Treatment of Chronic Plantar Fasciitis During a 36-Month Follow-Up Period: A Randomized Controlled Trial. The Journal of Foot and Ankle Surgery, 57(5), 913-918. doi: 10.1053/j.jfas.2018.03.017