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Plantar fasciitis- next steps

Your doctor has diagnosed you with plantar fasciitis. What are your next steps? Here are some common options your doctor is likely to discuss with you, and some pros and cons of each, including reflexology. 

Several treatment options are available to address pain symptoms from plantar fasciitis, but many have not been studied adequately enough (Cole et al, 2005).

Resting, icing, and over-the-counter pain relievers- These are common first steps in addressing the pain symptoms caused by plantar fasciitis (Mayo Clinic, 2018). Resting and icing in particular are very low-risk options that can have significant benefits, making them a good starting point. 

Stretching and strengthening- A skilled physical therapist can provide you with a stretching and exercise routine that is best suited for your needs. With plantar fasciitis, stretching the plantar fascia itself rather than the gastrocnemius (calf muscle) is generally recommended (Cole et al, 2005). Another gentle technique is to roll a ball along the sole of the foot. (I recommend a racquetball as a good, cost effective, easy-to-clean option). 

Several studies have supported the hypothesis that reduced strength of the plantar flexor muscles (muscles that flex the toes), and abductor hallucis muscles (which move the big toe away from the midline of the foot), along with reduced muscle volume in the forefoot are contributing factors in plantar fasciitis. The strength of abductor and lateral rotator muscles of the hips is also considered a risk factor (though a lower risk factor than foot muscle strength and volume) because these leg muscles help dictate the alignment of the lower limbs and influence gait patterns (Kamonseki, 2016). However, despite muscle weakness being a risk factor, studies on the benefits of strengthening in combination with stretching have been inconclusive, and consensus is lacking regarding the ideal number of repetitions for strengthening exercises (Kamonseki, 2016). That said, this is another low-risk, non-invasive option that is definitely worth exploring before considering more invasive procedures. 

Reflexology- Many of my clients see faster and more thorough improvement in their pain symptoms when they combine reflexology with some of the options described above. Several studies point to the efficacy of reflexology for pain relief for a wide variety of conditions. It is unknown exactly how and why reflexology works, but the leading theory is that it helps to calm the nervous system, allowing the body’s own healing mechanisms to be more effective. By working directly on the feet, blood flow is also increased to affected areas, helping with the healing process. Reflexology is also considered to be a very safe technique, making it another worthwhile option to try early on before any invasive procedures. As a clinical reflexologist, I am an advocate of combining multiple techniques and collaborating with medical providers, physical therapists, chiropractors, massage therapists, and other practitioners so clients receive the best possible care through a more integrated approach that is suited to the client’s specific needs and goals.

Orthotics- The support and alignment provided by orthotics can be an alluring option. However, there are a few important factors to consider. Evidence for the efficacy of this treatment is lacking and current evidence does not support custom-made orthotics being more effective than standard off-the-shelf orthotics (Cole et al, 2005). As noted in the previous blog, “Plantar fasciitis- causes and prevention,” poorly sized or shaped shoes can have a huge impact on foot health. Before trying orthotics, make sure you are wearing a shoe that works well for your foot. For some pointers, see “5 Tips for Healthy Shoes.” At Mpath, LLC, all new clients’ feet are measured and footwear options are discussed. I have seen many clients who have had custom orthotics made, but are wearing them in a shoe that does not fit. If the orthotic is being used in a shoe that is the wrong size, it will not have the desired therapeutic outcome. 

Many orthotics are also very stiff, and brace the foot in a particular position. While this may alleviate pain in the short term, it can also cause muscle imbalance. It is important to have a plan for longer term pain relief and strengthening, so you can be pain-free to do the activities you enjoy.      

More invasive options- Custom-made night splints, corticosteroid injections, extracorporeal shock wave therapy, walking casts, and surgery are other treatments a doctor may recommend, but they vary in effectiveness. Corticosteroid injections are generally considered only for short-term pain relief and if initial, less invasive therapies fail to produce the desired result in decreased pain (Cole et al, 2005). As mentioned in the previous blog, there is mixed evidence regarding whether the cause of heel pain in plantar fasciitis is due to an inflammatory process versus a degenerative process. If it is due to a degenerative process, then corticosteroid injections are not as likely to be as effective as if there is a true inflammatory response. This is significant because corticosteroid injections (especially when administered in series) can result in plantar fascial rupture (a tear in the plantar fascia), causing more long-term damage and pain than the initial diagnosis of plantar fasciitis. In a study of patients with plantar fasciitis, in 86% of those who also had a plantar fascial rupture, the rupture was associated with a corticosteroid injection (Lemont et al, 2003). Likewise, surgery is generally only considered when all other less invasive techniques have failed (Cole et al, 2005).

Given the prevalence of plantar fasciitis and lack of conclusive evidence regarding its cause and efficacy of common treatment options, more research on this condition is needed. Determining specific causes of plantar fasciitis and if it is more accurately characterized as an inflammatory or degenerative process will help inform preventative measures and future protocols for managing pain symptoms more effectively. Similarly, current protocols and techniques should continue to be studied and adapted in order to provide better care for those whose daily lives are impacted by this painful condition.

 

Works Cited

Cole, Charles et al. “Plantar Fasciitis: Evidence-Based Review of Diagnosis and Therapy.”
American Family Physician,
vol. 72, no. 11, 2005, pp. 2237-2242,
https://www.ncbi.nlm.nih/gov/pubmed/16342847. Accessed 10 Oct. 2018.

Kamonseki, Danilo H. “Effect of stretching with and without muscle strengthening
exercises for the foot and hip in patient with plantar fasciitis: A randomized controlled
single-blind clinical trial.” Manual Therapy, vol. 23, 2016, pp. 76-82, https://doi.org/10.1016/j.math.2015.10.006. Accessed 5 Nov. 2018.

Lemont, Harvey et al. “Plantar Fasciitis: A Degenerative Process (Fasciosis) Without
Inflammation.” Journal of the American Podiatric Medical Association, vol. 93, no. 3,
2003, pp. 234-237, https://www.ncbi.nlm.nih.gov/pubmed/12756315. Accessed 10 Oct.
2018.

“Plantar fasciitis.” Mayo Clinic, 7 March. 2018, https://www.mayoclinic.org/diseases-conditions/
plantar- fasciitis/symptoms-causes/syc-20354846.

        


Melanie Giangreco