What Is Plantar Fasciitis?

A common problem encountered by physicians described as sharp pain, aching or stiffness on the bottom of one or both heels. The pain is usually localized to the bottom of the foot where the heel comes in contact with the arch at the attachment of the plantar facia (a ligament/fascia extending from the heel to the toes).

The pain is usually worst first step in the morning, after long periods of rest/sitting or after long periods of standing and ambulation.

Although this is a very common problem in adults, children can't have plantar fasciitis.

How Is Plantar Fasciitis Diagnosed?

Plantar fasciitis is a common problem that should be diagnosed through some very distinct steps:

Physical Exam: The most important diagnostic technique is the exam. The pain should be localized to the bottom of the heel (not ball of the foot or back of the heel). A good physical exam confirms the probability of the diagnosis.

X-ray: Although x-rays are commonly performed to look for heel spurs, that is not the reason an x-ray is recommended. The heel spur is actually a symptoms of the problem and doesn't usually need to be even treated. The x-ray is to confirm absence of cysts, stress fractures and other bone abnormalities.

Ultrasound: The most effective diagnostic exam for plantar fasciitis is an ultrasound. Through ultrasound you can measure the plantar fascial thickness and confirm plantar fasciitis!

Your doctor should diagnose your problem and help you find the appropriate solutions. Remember, you are the secret to getting better.

How To Treat At Home

As with most conditions of the foot and ankle, there are things you can do at home to treat (or prevent) plantar fasciitis.

Here are some important things to think about:

Prevention: The most effective treatment for plantar fasciitis is prevention! Some common ways to prevent plantar fasciitis include: stretching, proper shoe gear, and shoe inserts/orthotics. Get Your Key Prevention Options For Plantar Fasciitis.

Activity: The first step to selfcare is managing activity. Now as opposed to many specialists we are not an advocate of “stopping” activities to resolve your plantar fasciitis. If we were to take you off your feet or even put you in a cast or walking boot you could resolve your pain quickly – (2-4 weeks). The problem with this treatment, however, is that plantar fasciitis usually comes back with a vengeance when you return to activity. Therefore, it is instead important to manage the activity that you are doing by reducing to a level that allows recovery without stopping.

Ice: Through careful use of ice, inflammation and associated pain can be reduced. Common methods for inflammation reduction include: rolling on a frozen water bottle, frozen peas (vegetables), or ice massage.

Deep Tissue Massage: One of the other more effective selfcare processes is deep tissue massage. This can be done with the help of physical therapy, a masseuse or even just a family member rubbing the area deeply. It can also be done through use of a tennis ball, golf ball, racquet ball or lacrosse ball. The deep massage is very valuable at both reducing pain and stimulate blood flow to the area.

How To Treat At Home

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When To See The Doctor?

Although plantar fasciitis can be improved and sometimes even resolved through appropriate selfcare or self-treatment, there are many times when professional help can both improve the outcomes and speed the resolution. In this chapter my goal is to help you know WHEN you should progress to professional help and not keep waiting.

Stop Expecting It To Just Resolve: First things first, if you haven’t realized this already, let me be the first to tell you that plantar fasciitis usually will NOT resolve itself without treatment. In fact, it usually continues to progress and can lead to pain in other areas of the foot or leg because of how you are walking (how you are accommodating for the pain). I therefore invite you to stop waiting for it to resolve and at least start selfcare and self-treatments. If these treatments are not working relatively quickly, it is worth reaching out for assistance in resolving your foot pain. You deserve to get back to normal activities without the pain of plantar fasciitis.

How Long Is Too Long?: The big question that you may be asking yourself is how long should you wait? I would love to say you should go into the doctor immediately, but I don’t believe that to be the case. In fact, I often attempt personal care as well before being seen by a doctor. You have that same right! You should therefore look carefully at your symptoms and the associated disability and go in when: 1) The pain is such that it is now keeping you from doing what you love to do. 2) The symptoms are progressing and causing other pain or injury (other foot, different parts of the foot or even up the legs). In either case I recommend you be seen immediately so you can get the resolution also more quickly.

Recovery Is Quicker With Help: The truth is your symptoms will decrease more quickly and the resolution or recovery will be much faster with the correct instruction and treatment options. Do you need a doctor to recover from plantar fasciitis? No, but most individuals find significant speed in resolution once they get professional guidance and diagnosis

What Additional Help Is Available?: A doctor visit will do the following for you: 1) Help confirm the diagnosis. 2) Reduce the inflammation (and pain). 3) Prevent recurrence.

Specialized Treatment Protocol

Although most doctors only focus on reducing the inflammation (to reduce the pain), there is a very important second step that must be done or plantar fasciitis often returns:

STEP 1: Reduce The Inflammation: One of the most important steps to reducing pain is reducing the inflammation of the plantar fascial ligament.

STEP 2: Prevent Recurrence: After reducing the inflammation and helping the plantar fasciitis resolve, it is important to prevent recurrence. Often (at least 50% of the time) plantar fasciitis will return if this step isn't followed.

Reduce The Inflammation

Using Medications To Reduce Swelling: One of the ways to reduce inflammation and therefore improve pain is through the use of anti-inflammatory medications. These could include aspirin, non-steroidal anti-inflammatory medications like ibuprofen, or steroid type medications like the Medrol Dose pack or prednisone. All these medications are designed to interrupt the inflammatory process and reduce swelling. These are a good option for short-term treatment of pain associated with swelling while you work to modify your activities or reduce the inflammation through other means.

Foot Strapping: Another very effective method to allow inflammation resolution is to stop the injury to the plantar fascia. Some doctors will attempt to do this through orthotics or arch supports, but this commonly increases pressure to the plantar fascia and can aggravate the pain. A more effective method is through a special taping technique called the low-dye strapping or taping technique. Low-dye strapping is actually designed to both decrease pressure across the plantar fascia and produce medial arch support. If performed correctly, this is a very effective treatment method!

Injectables: A very common treatment modality is injections, especially cortisone type injections, for treating the inflammation of plantar fasciitis. Injecting a corticosteroid to the plantar fascia, either under ultrasound guidance or not, can be utilized to treat the pain and inflammation associated with this disease process. Studies have shown that this type of injection can assist in the resolution of plantar fasciitis in approximately 80% of individuals when administered as a series of 1-3 injections. The goal of treatment is to decrease the inflammation of the plantar fascia over a 4-to-6-week period and stimulate plantar fascial healing by the simple act of “needling” the plantar fascia as part of this process.

Revolutionary Laser Treatment: One of the most effective conservative treatments for treating plantar fasciitis is MLS Laser therapy. Through this treatment we both decrease inflammation of the plantar fascia and decrease pain while stimulating the plantar fascia at the cellular level to heal. Let me go into a little bit more depth to help you understand how this treatment works.

MLS (Multiwave Locked System) Therapy Laser is a class IV laser that utilizes a proprietary and patented delivery system to synchronize two therapeutic laser wave-lengths, 808nm and 905nm. It is also designed to penetrate the 3-4 cm depending on the tissue type and produce the following biological benefits:

The 808 nm wavelength provides anti-inflammatory and anti-edema effects via a continuous wave delivery.

The 905 nm wavelength provides analgesic effects, and improves cellular metabolism with potential acceleration of tissue repair or cell growth via a pulsed mode laser energy.

Through this treatment we are seeing greater than 85% resolution of plantar fascial swelling and associated symptoms. This is consistent with studies run on this technology. We have also found healing to improve in all tissues treated.

Anti-Inflammation: Anti-edema benefit through vasodilation (dilating vessels) and activation of the lymphatic drainage system (drains swollen areas). As a result, there is a reduction in swelling caused by bruising or inflammation.

Anti-Pain (Analgesic): Analgesic effect through blocking pain transmittal from nerve cells to the brain and decreased nerve sensitivity. Production of endorphins and encephalins from the brain and adrenal gland also block pain transmission. The final benefit of pain relief comes from reduced inflammation and edema to the area.

Accelerated Tissue Repair and Cell Growth: Cellular penetration of laser photons accelerate cellular reproduction and growth through increased cellular energy. This leads to incorporation of nutrients faster and rapid waste removal. As a result, the cells of tendons, ligaments and muscles are re-paired faster.

Improved Vascular Activity: Increased formation of new capillaries in damaged tissue that speeds up the healing process, closes wounds quickly, and reduces scar tissue. Additional benefits include acceleration of angiogenesis, which causes temporary vasodilatation (dilating vessels).

Increases Metabolic Activity: Improved cellular metabolism through output of specific enzymes, greater oxygen and food particle uptake of cells.

Reduced Fibrous Tissue Formation: Cellular remodeling reduces the formation of scar tissue following tissue damage from cuts, scratches, burns or surgery.

Improved Nerve Function: More rapid nerve cell repair, reconnection and increase the amplitude of action potentials to optimize muscle action.

Immunoregulation: Stimulation of immunoglobins and lymphocytes and improved cellular metabolism to improve immune response and function.

Faster Wound Healing: Stimulation of fibroblast development (fibroblasts are the building blocks of collagen, which is predominant in wound healing) in damaged tissue produces increased collagen and improved healing of open wounds and burns.

Prevent Recurrence

Plantar fasciitis is a common problem that should be diagnosed through some very distinct steps:

Change Your Activities: The first piece of the puzzle when preventing recurrence is a careful evaluation of what caused your plantar fasciitis in the first place. What activities caused the symptoms and can those activities be modified or eliminated? (NOTE: We do not advocate elimination of regular activities like walking or activities that you enjoy but instead looking at ways these activities can be modified to prevent reinjury.

Achilles Tendon Stretching: Another option is to modify activities through appropriate stretching. Almost none of us stretch enough! Stretching the calf muscle is very important in preventing recurrence. The biggest cause of plantar fasciitis is a tight Achilles tendon. As you stretch multiple times a day, the tendon will lengthen over time. This is a principle called Wolf’s Law and has been proven time and time again. (Special Note: Stretching the plantar fascia is neither effective nor recommended at this time as it usually makes things worse.)

Splinting: One effective way to utilize Wolf's Law is to utilize night splinting to maintain stretch of the Achilles tendon while sleeping. There are multiple forms with various efficacy.

Appropriate Shoes: Another very effective method to reduce recurrence, and often even help in the resolution of plantar fasciitis, is wearing the appropriate shoes for the activity. This is more than just wearing “good” shoes.

Specialized Inserts and Orthotics: Many doctors recommend specialized insoles, inserts or orthotics as a first line of treatment for plantar fasciitis. The principle is the same as utilizing a good quality shoe during the recovery process. The negative, however, is often these insoles increase the pressure to an already swollen and tender plantar fascia and can even aggravate the problem more. A good quality orthotic after recovery (in the prevention stage) can be invaluable in returning to regular activities without the risk of recurrence!

When Surgery Is Necessary

In rare situations (< 15%) when the conservative treatments aren't working, or the prevention has failed and it keeps coming back, surgery may be necessary. But traditional surgeries are only 50% effective. Therefore we searched for years for a better option and found Topaz Radiocoblation.

The Topaz Procedure: Topaz Radiocoblation has been found to be very effective. In fact, we are getting close to 90% efficacy with this minimally invasive surgery. It is performed through pin holes requiring no incision. The best part, however, is that you are in normal shoes and returning to normal activities in a matter of days!

Learn more about this revolutionary treatment by making an appointment.