Buchberger: An update on plantar fasciitis
PHYSICAL THERAPY

Buchberger: An update on plantar fasciitis

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Foot

Plantar fasciitis is considered the most common cause of heel pain. The plantar fascia is a thick band of tissue that connects the heel to the toes. From the heel, the connection continues up the backside of the calf into the Achilles tendon. The plantar fascia also has a poor blood supply, exposing it to chronic overuse conditions.

The most common symptom associated with plantar fasciitis is foot and/or heel pain when placing the painful foot on the floor and taking the first steps of the morning, or after sitting for a long time. The stiffness and pain may reduce after taking a few steps. But your foot may hurt more as the day goes on. It may hurt when climbing stairs, or with prolonged standing or running.

There are many contributing factors leading to plantar fasciitis. Most of us would like a nice, neat cause-and-effect answer to the question, “What causes plantar fascitis?” Unfortunately, there are fewer causes and more contributing and risk factors associated with plantar fasciitis. It appears to be a condition where the perfect storm is necessary to bring on the condition.

The most common contributing and risk factors to develop plantar fasciitis are obesity, stiff calf muscles, a tight Achilles tendon, flat feet, high-arched feet, adrenal fatigue, diabetes, etc. If you have a non-mechanical systemic contributing factor such as adrenal fatigue, diabetes, psoriatic arthritis, etc., these must be kept under control in order for the mechanical treatment to work.

There are many different treatments that have been tried to alleviate the pain of plantar fasciitis. Initially, rest from the exacerbating activity, over-the-counter NSAIDs such as ibuprofen or naproxen, ice massage and gentle stretching of the plantar fascia and the calf. If you are not getting relief with this simple home treatment regimen within 14 days, physical therapy is the next course of treatment. Physical therapy will address any weakness in the legs and hips, as well as directly manipulate the plantar fascia and the muscles of the leg.

Dr. Dale Buchberger

Dr. Dale Buchberger

There are many other types of soft tissue treatments such as Active Release Techniques (activerelease.com) or instrument-assisted soft tissue mobilization (sastm.com) that address poor blood flow in the fascia. These techniques are valuable when combined with specific flexibility and eccentric-type strengthening exercises. The flexibility and strengthening exercises must be performed on a regular basis and at loads heavy enough to make a difference. When a physical therapist combines aggressive soft tissue treatment and flexibility and strengthening exercises with therapeutic ultrasound, a positive change in the tissue structure can be made. These techniques are classified as compressive techniques. It is not uncommon to combine them with a distractive technique, such as cupping therapy.

Extra-corporal shock wave therapy is new and has had some promising results with plantar fasciitis and heel spurs in particular. The therapy unit delivers a shock wave of energy through the skin and into the tissue to be treated. This has a deep mechanical effect on the tissues while also improving blood flow. Together, this will help the injured tissue regenerate. Again, this therapy does not work by itself. The ESWT treatment must be accompanied by the appropriate flexibility and eccentric strengthening exercises to get the best result.

If these various treatments fail to yield a resolution to the painful foot, there are a variety of injections that can be performed in conjunction with flexibility and strengthening exercises. While a cortisone injection is the most common injection, platelet-rich plasma injections are showing promising results in the right candidates. These injections use the patient’s own blood cells to heal the painful fascia. The goal of the cortisone injection is to reduce inflammation. Unfortunately, the pain associated with most cases of plantar fasciitis is related to degeneration of the fascia and not inflammation. Therefore, PRP may actually be a better physiological choice to remedy plantar fasciitis.

In many cases of stubborn plantar fascitis, several or all of these options need to be combined with the appropriate exercise program and medical management of any underlying comorbidity in order to achieve the desired result.

Lastly, recognizing when your shoes are ready to be replaced, or when you simply need new or better shoes, can be the difference between a quick recovery or falling into a chronic and lengthy problem. Shoes don’t last as long as we think, and most shoes are the definition of planned obsolescence. You may also need to change the specific type of shoe. As we age, our bodies don't accept the pounding as well, and we need shoes with more advanced cushioning. In most cases, foot pain does not resolve without treatment. Finding out the cause or causes of the pain is the key step in getting the pain to resolve so you can return to your chosen activities.

Dr. Dale Buchberger is a licensed chiropractor, physical therapist, certified strength and conditioning specialist, and a diplomate of the American Chiropractic Board of Sports Physicians, with 31 years of clinical sports injury experience. He can be contacted at (315) 515-3117 or activeptsolutions.com or shouldermadesimple.com.

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