By Reiss C Gridley, B.Sc. (Hons)
Plantar fasciitis (or fasciopathy) is a debilitating condition which can make people feel like they are walking on glass. The most common site of pain is underneath the foot or pain around the heel. It usually occurs with first steps in the morning or after long periods of sitting.
The plantar fascia is a band of connective tissue that runs from the calcaneus (heel bone) to the toes. The main reason the plantar fascia becomes painful is because the collagen (which makes up the connective tissue) degenerates.
The cause of the degeneration is repetitive micro-tears of the plantar fascia that overcome the body’s ability to repair itself (Young et al, 2001).
Although it is a common practice to use cortisone injections on plantar fasciitis it has many complications. Plantar fascia rupture which can lead to long term pain and can be extremely hard to treat. Or, fat pad atrophy which causes heel pain.
A cortisone injection is a strong anti inflammatory that eliminates inflammation to the area in which it is administered. The problem with this, is that modern research suggests that plantar fasciitis is actually a degenerative condition (fasciosis) without inflammation.
One study found that treatment regimens such as serial corticosteroid injections into the plantar fascia should be re-evaluated in the absence of inflammation and in light of their potential to induce plantar fascial rupture.
(Lemont et al, 2003)
It mostly occurs in runners because of the repetitive stress and accounts for around 10% of running injuries (Chandler and Kibler, 1993). It can also occur in people with metabolic disease like diabetes which affects the body’s ability to heal itself.
How to treat plantar fasciitis?
At Back to Life we use a well-researched method of treatment called radial shockwave therapy. Pressure waves emitted by the shockwave machine into the plantar fascia stimulates healing response. Not only does it stimulate repair of the degenerated collagen, it will stimulate the nerves to decrease pain.
In a review of 9 different studies by Lou et al. they found that shockwave therapy improved the success rate of reducing overall heel pain, reducing pain at the first step in the morning and during daily activities and reducing heel pain after application of a pressure.
Very slow strength training seems to be the modern ‘Treatment craze’ when it comes to tendon injuries. Which is why a new study looked at applying its effect on plantar fasciitis.
A study by Rathleff et al. found that high‐load strength training may aid in a quicker reduction in pain and improvements in function.
We use strength training after the first session of shockwave so that we can stimulate the repair of the tendon as quickly as possible.
3 Tips on what to avoid with plantar fasciitis
- Do not wear high heels or any dress shoes that aggravate the pain – wear comfy trainers
- Do not do any aggravating activity like running or standing for long periods
- Runners do not start running again until the heel is pain free for 4 weeks and you can walk 10 kilometres without pain on the day, or the following day.
Young C C, Rutherford D S and Niedfeldt M W, American Family Physician. 2001, 63 (3): 467-475.
Lemont H, Ammirati K M and Usen N Plantar Fasciitis. Journal of the American Podiatric Medical Association. May 2003, 93(3): 234-237.
Tatli YZ, Kapasi S. The real risks of steroid injection for plantar fasciitis, with a review of conservative therapies. Curr Rev Musculoskelet Med. 2008;2(1):3-9.
Chandler T J, Kibler W B. A biomechanical approach to the prevention, treatment and rehabilitation of plantar fasciitis. Sports Med. 1993;15.
Lou J, Wang S, Liu S and Xing G. Effectiveness of Extracorporeal Shock Wave Therapy Without Local Anaesthesia in Patients With Recalcitrant Plantar Fasciitis: A Meta-Analysis of Randomized Controlled Trials. American Journal of Physical Medicine & Rehabilitation. 2017, 96 (8): 529–534
Rathleff M S, Mølgaard C M, Fredberg U, Kaalund S, Andersen K B, Jensen T T, Aaskov S and Olesen J L, High‐load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12‐month follow‐up. Scandinavian journal of medicine and science in sports 2015, 25 (3): 292-300.