When Pain Interferes with Daily Life
PLANTAR FASCIITIS
Adam Rodnick
DC
Though many people spend much of their day at a desk, not being able to stand or walk without sharp pain can be a major hinderance to functioning normally. Imagine waking up and feeling great at first, but as soon as you put your feet on the ground, having the sensation of a nail stabbing into your heel, or the pain of a ‘constant toothache’ in the bottom of your foot. These are just some of the ways my patients have described the symptoms of their plantar fasciitis to me.
Plantar fasciitis accounts for an estimated one million doctor visits per year in the United States and is the cause of about 25% of all foot injuries in runners Plantar fasciitis, sometimes called ‘heel pain syndrome,’ is the most common cause of pain in the heel. The condition is often characterized by stabbing and/ or burning pain that is worse in the mornings and after periods of rest. Approximately two-thirds of patients first seek treatment for this debilitating condition from their family physicians.2 Conventional treatment prescribed usually includes NSAIDS, stretching, and lifestyle modifications, which often fail to relieve symptoms and resolve the issue. Identifying and diagnosing the condition can be straightforward and is primarily clinical. The diagnosis doesn’t require x-ray or MRI, which may be a reason many people suffering from the condition don’t seek treatment early or the opinion of a specialist.
Plantar fasciitis can result from a variety of causes, such as gradual degeneration of the plantar fascia or even sudden trauma to the heel, like running over a rock. A possible pathogenesis of plantar fasciitis is repetitive microtrauma and inflammation of the plantar fascia at the calcaneal insertion.3 Obesity and over-pronation can also be comorbidities to the condition. While a person sleeps, the foot naturally tightens and the toes often point, causing additional microtrauma and micro-tearing with the first few steps in the morning. This often creates a vicious cycle that can require 10 months for recovery, which can be aided by night splints and custom orthotics.
The plantar fascia arises mostly from the medial process of the calcaneal tuberosity and attaches distally, through several slips, to the plantar surface of the forefoot.4 It is divided into three bands: medial, lateral, and central. The central band is the predominant component. Patients with plantar fasciitis can and should be encouraged to participate in their own recovery by doing a variety of home-based modalities. Icing and massaging the sore fascia can be an effective aid to healing. An easy way for patients to do this is by rolling the foot over a frozen water bottle or Foot Wheel. Stretching is also an effective treatment that patients can perform at home. Stretching the plantar fascia can help alleviate pain, while stretches that focus on the Achilles tendon can help stabilize and strengthen the ankle and heel, which allows for less pressure to be placed on the fascia while standing or walking. Rest and avoiding improper footwear, such as stilettos and other high heels, should also be considered.
In the clinical setting, chiropractic massage, shockwave therapy, low level laser, Kinesio taping of the arches, prescription of night splints, and custom orthotics, have all proven to be great non-surgical options to aid in recovery from plantar fasciitis. A 2011 systematic review that included two randomized controlled trials on the use of manipulative therapy by chiropractors for plantar fasciitis concluded that CMT is an effective method for short-term pain relief.5 A 3-arm RCT conducted by Roos et al. (2011) that compared three groups - one using only custom orthotics, one using night splints, and one using both - indicated that the use of anterior night splints and custom orthotics were both effective in providing short-term pain relief and improved foot function.6
Custom-made orthotics can help position the foot for healing and should be worn as often as possible so that there is less reaggravation of the fascia and symptoms between in-office treatment sessions. Custom orthotics can be made for any style of shoe or footwear, including flats, wedges, and even flip-flops or sandals. Custom orthotics can be compared to and act similar to prescription eyewear. Many people have multiple pairs of prescription eyewear, such as sunglasses, sports goggles, or contact lenses, that allow their eyes to function perfectly while using prescription products. Orthotics can do the same thing for the foot, allowing for it to be properly supported and positioned for healing and normal function. Often, though, a patient may only wear them in one pair of their shoes, creating more tension and inflammation when they wear high heels or flipflops. Proper support at all times will allow for the fastest recovery. A 2009 study indicated that customized orthotics reduced rearfoot peak forces bilaterally and are useful in distributing pressure uniformly over the rearfoot region.7
Ultimately, a combination of therapeutic modalities both in-office and administered at home is the most effective approach to achieving the fastest recovery from plantar fasciitis. Multiple therapeutic modalities should be considered at the clinician’s discretion.
Dr. Adam Rodnick practices at Rodnick Chiropractic in Commerce Township, Michigan. Dr. Rodnick is a 2006 graduate of Life University.
References:
1. Riddie D L, Schappert SM. Volume of ambulatory care visits and patterns of care for pati ents diagnosis with plantar fasciitis: a national survey of doctors. Foot Ankle Int 2004;25:303-10
2. Goff J, Crawford R. Diagnosis and treatment of plantar fasciitis. American Family Physician. 2001;84(6):676-682.
3. Cutts S, Obi N, Pasapula C, Chan W. Plantar fasciitis. Annals of the Royal College of Surgeons of England. 2012;94:539542
4. Sarrafian SK. Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional. New York: JB Lippincort Company 1983
5. Brantingham JW, Bonnefin D, Perle SM, et al. Manipulative therapy for lower extremity conditions: update of a literature review. Journal of Manipulative and Physiological therapeutics. 2012;35:127-166.
6. IJden Ft, Boesh E, Kumar S. Plantar fasciitis - to jab or to support? A systematic review of the current best evidence. Journal of Multidisciplinary Healthcare. 2011;4:155-164
7. Chia J, Suresh S, et al. Comparative Trial of the Foot Pressure Patterns between Corrective Orthotics, Formthotics, Bone Spur Pads and Flat Insoles in Patients with Chronic Plantar Fasciitis. Ann Acad Med Singapre 2009;38:869-75
