Don’t Let Plantar Fasciitis Stop You in Your Tracks
By: Dr. Kim C. Tran, D.C.
Waking up and agonizing over the first footsteps of the day? You may be suffering with plantar fasciitis. Affecting over two million people in the United States, plantar fasciitis is the most common cause of foot pain.
Plantar fasciitis is characterized by sharp medial heel pain that may also extend through the entire foot into the toes. It is typically most painful after getting out of bed or after a period of inactivity. The discomfort often improves after walking and moving throughout the day with pain returning in the evening. Symptoms can also increase after long periods standing, walking, running, hiking, or especially when using the stairs. Contributing factors include muscle tightness in the calves and achilles tendons, weakness or instability of the ankles, and trauma to the feet resulting in scar tissue or a dropped arch. In addition, a low back or sacral misalignment can also contribute. Degeneration of the plantar fascia may also increase with age. The causes vary from person to person, it is best to discuss symptoms with a health care provider trained in musculoskeletal disorders and syndromes to determine the correct diagnosis and treatment.
Additional risk factors include:
- Obesity – Substantial weight can increase pressure exerted on the planter fascia of the foot, which can damage the fascia – resulting in plantar fasciitis.
- Heel spurs are often a reaction to chronic plantar fascia tension.
- Instability of the ankle and foot.
- Flat feet or loss of arch height.
- Decreased flexibility of the muscles in the foot.
- Decreased range of motion of the foot and ankle.
- Improper footwear – including flip flops, high heels or worn out shoes/boots. • Foot trauma resulting in scar tissue.
- Repetitive movement.
Conservative care, such as chiropractic care, has been shown to be successful with 95 percent of patients. Resolution time of plantar fasciitis is typically about 6-18 months, however, early recognition and treatment of plantar fasciitis is best as this can lead to a shorter recovery time.
There are many treatment techniques for plantar fasciitis. To manage symptoms, start with the following:
- Ice – Soak feet in an ice water bath for 15-20 minutes as necessary. Rolling a water bottle that has been frozen under your feet is also a good option.
- Epsom salt bath – Magnesium deficiency is a common cause of tight muscles, soaking can help to relax calf and foot muscles.
- Stretching- Stretch feet and calves several times throughout the day holding 15-30 seconds per side.
- Strengthening exercises – Rehabilitation of your feet is also important to strengthen the muscles, toe curls and standing calf raises are great strengthening exercises.
- Modification of activity – Avoiding or reducing activities that aggravate and increase pain in feet.
- Self Massage – Using a golf ball, massage from the heel through the middle of the foot into the toes for 30 to 60 seconds. Avoid rolling over bones.
Furthermore, in addition to at-home care, treatment by a health care provider can assist with recovery from plantar fasciitis. Chiropractic adjustments have been shown to have a favorable response, by increasing the mobility of joints with decreased or altered motion. Adjustments specifically to the foot and ankle, combined with daily stretches have been shown to decrease foot pain. The chiropractor may also do a movement assessment to determine if there are other muscle imbalances or other joints in the body (including the low back, hips, and knees) that may be contributing to plantar fasciitis.
Customized shoe orthotics may also be recommended to help support the fascia, arch and heel. While it is tempting to grab the “one size fits all” orthotics off of the shelf, customized orthotics that are based on your feet, weight distribution and leg length provide the best support for your body.
Conservative care treatment may also include the following:
- Myofascial Release – This therapy utilizes movement, manual contacts and sometimes instruments to break down scar tissue and adhesions allowing the muscles and fascia to stretch and heal correctly.
- Laser therapy, muscle stimulation and other therapeutic techniques may be effective in the reduction of pain and inflammation.
- Kinesiology taping of foot and calves to support the arch and reduce inflammation, resulting in reduced strain on the fascia.
- Night splints holds the foot in a flexed position at night to stretch the fascia. It also prevents the fascia from healing in a shortened, non-functional state.
Minimally Invasive Care
- Extracorporeal shock-wave therapy is claimed to promote new vasculature in the tissue to promote healing and is usually applied under IV sedation.
- Steroidal injections can have a short-term benefit that often does not exceed six months. Multiple injections can result in decreased heeling and tissue integrity.
- Anti-inflammatory drugs, such as ibuprofen, naproxen or steroids, may help decrease pain. However, relying on these medications delays skeletal muscle healing by decreasing the regeneration of the muscle tissues and increasing the scar tissue.
Surgical treatment of plantar fasciitis should be a last resort after conservative care has been exhausted.
Plantar fasciitis is estimated to affect 1 in 10 people in their lifetime and can be effectively treated with conservative care in 95 percent of cases. Early recognition and treatment of plantar fasciitis yields the best results and allows for better quality of life. Consult a health care provider that is trained in musculoskeletal disorders and syndromes, such as a chiropractor, to determine if you have plantar fasciitis and to rule out any other causes of foot pain.
For more information, call today to schedule your appointment.
- Forcum T, Hyde T, Aspergen D, Lawson G. Chiropractic Round Table: Plantar Fasciitis and Heel Pain. J American Chiropractic Association 2010 Oct; 47(5): 26-33.
- Souza T. Differential Diagnosis and Management for the Chiropractor Fourth Ed 2009.