Plantar fasciitis is a common cause of heel pain experienced by millions of Americans and can lead to difficulty walking, running or even standing without pain. Let’s talk about the signs and causes of plantar fasciitis, as well as the treatment options to treat it and get back to moving without pain.
What Are the Signs & Symptoms of Plantar Fasciitis?
The plantar fascia is a ligament that runs from your heel through the bottom of your foot and provides support to the foot’s natural arch, especially during weight bearing, or running.
Common Symptoms of Plantar Fasciitis Include:
- Heel pain, especially worse after periods of inactivity (e.g. after sitting for a while or upon first waking up)
- Pain with putting excessive pressure on your heel and arch (e.g. jumping, walking, going up a flight of stairs, etc.)
How is Plantar Fasciitis Diagnosed?
In the context of the above signs and symptoms, a physical exam may reveal point tenderness at the site of attachment of plantar fascia. This can increase the suspicion of the evaluating healthcare provider. This diagnosis can then be confirmed with Ultrasound or MRI imaging if necessary.
Popular Plantar Fasciitis Treatments
Generally, the first line of treatment for plantar fasciitis is a stretching routine and exercises. Some patients may take NSAIDs like ibuprofen in the short term, but these should be avoided long term due to side effects. Other options for management include night splints (to keep the plantar fascia in an elongated position) or custom orthotics to relieve some pressure on the plantar fascia while weight bearing.
Steroid injections are commonly performed to try to relieve pain for plantar fasciitis in the short term, however there are significant risks and side effects with this approach. Steroids can potentially cause fat pad necrosis in the heel and lead to permanent deformity and heel pain. Other side effects with steroid injections include weight gain, immune system suppression, osteoporosis and increased blood sugar.
Orthobiologics like Platelet Rich Plasma have been shown to be effective and may be an appropriate option to discuss with your physician.
Shockwave for Plantar Fasciitis
Extracorporeal Shockwave Therapy, ESWT for short, is a treatment option where Shock Wave Energy is delivered into damaged tendons, bones, ligaments and other tissues to stimulate neo-angiogenesis (new blood flow), decrease inflammation and help the target tissue remodel and heal.
Specifically, for plantar fasciitis there are numerous studies with a high level of evidence supporting the use of shockwave treatments.
A randomized controlled trial in 2015 from the Journal of Bone and Joint Surgery (1) showed that patients with recalcitrant plantar fasciitis treated with a shockwave device, reported pain reduction in 69.2% of the patients in the ESWT group compared with 34.5% in the control group.
Another trial published in the same journal (2) concluded that ESWT is effective and safe and that the clinical improvement lasts beyond 1 year and a third randomized controlled trial (3) comparing ESWT with conservative treatment found that the shockwave group had excellent or good results in 82.7% of the patients compared with 55% in the control group at a follow-up of between 60 and 72 months. Additionally, the shockwave group had a much lower recurrence rate in this study.
Furthermore, Three meta-analyses (4-6) have reviewed multiple randomized clinical trial and have found that ESWT is effective and safe for treating chronic plantar fasciitis.
What to Expect from Shockwave Treatments
ESWT procedures utilize a non-invasive probe applied to the skin of the target being treated. The probe delivers energy into the plantar fascia. Patients may feel some mild aching or discomfort while the probe is on the affected tissue. There is not a need for local anesthetic or pain meds and a typical treatment takes around 10 min. Most patients do not have any downtime following treatment, although occasionally minor soreness or bruising can occur.
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(1) Gollwitzer H, Saxena A, DiDomenico LA, Galli L, Bouché RT, Caminear DS, Fullem B, Vester JC, Horn C, Banke IJ, Burgkart R, Gerdesmeyer L. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. J Bone Joint Surg Am. 2015 May 6;97(9):701-8.
(2) Ogden JA, Alvarez RG, Levitt RL, Johnson JE, Marlow ME. Electrohydraulic high-energy shock-wave treatment for chronic plantar fasciitis. J Bone Joint Surg Am. 2004 Oct;86(10):2216-28.
(3) Wang CJ, Wang FS, Yang KD, Weng LH, Ko JY. Long-term results of extracorporeal shockwave treatment for plantar fasciitis. Am J Sports Med. 2006 Apr;34(4):592-6.
(4) Aqil A, Siddiqui MRS, Solan M, Redfern DJ, Gulati V, Cobb JP. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs. Clin Orthop Relat Res. 2013 Nov;471(11):3645-52. Epub 2013 Jun 28.
(5) . Chang KV, Chen SY, Chen WS, Tu YK, Chien KL. Comparative effectiveness of focused shock wave therapy of different intensity levels and radial shock wave therapy for treating plantar fasciitis: a systematic review and network meta-analysis. Arch Phys Med Rehabil. 2012 Jul;93(7):1259-68. Epub 2012 Mar 12.
(6) Dizon JN, Gonzalez-Suarez C, Zamora MT, Gambito ED. Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis: a meta-analysis. Am J Phys Med Rehabil. 2013 Jul;92(7):606-20.