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Plantar Fasciitis - Common Reason for Heel Pain
We rely on and use our feet constantly. They are the source of our transport from place to place, the means to our movement in sport, dance, recreation, fitness and work.
They enable our bodies to balance, move, jump, sprint and carry immense loads of weight whilst navigating the terrain they land on.
For most, we won’t experience heel pain. But for a big portion of the population, heel pain can be an immense disruption to our daily routine. Heel pain can have many clinical presentations. For the purpose here we will look at Plantar Fasciitis, it’s presentation, diagnosis and treatment. It is a common complaint in the clinic and I for one have experienced this firsthand.What is Plantar Fasciitis exactly?
A common cause for heel pain. Heel pain can affect around 10% of the general population. Plantar fasciitis or plantar fasciosis or plantar heel pain. Is the end result of a degenerative irritation and repetitive straining of the plantar aponeurosis. Occurring at the origin of the medial calcaneal tuberosity.
The role of the plantar fascia is to provide important biomechanics of the foot. It provides shock absorption, as well as maintaining the integrity of the foot arch. Understandably, the term ‘itis’ denotes inflammation, however this condition tends to lack the influx of inflammatory cells. Plantar fasciitis thereby is characterised by the absence of visual inflammation (redness, swelling, heat) and the pain is present at most when the fascia is placed under load or overstretch.
How will you know what the symptoms are?
This will present a progressive history of pain. Stemming from the medial aspect of the heel. The pain is described as a sharp stabbing. That is felt the most with the first few steps after getting out of the bed. This pain then slowly eases with ambulation, but may increase with further activity through the day.
A major complaint initially in the acute phase, is the feeling of a pebble or rock in the shoe. It may not be painful but that sensation is felt with each step. This can progress into a dull ache and then either sharp pain or burning sensation or both. This pattern will normally present worse in the morning and decrease through the day. Again flaring when resting.
Chronic phase presentations, which is the most commonly seen in the clinic for treatment, experience the extreme heel pain first thing in the morning for 10-15mins, until it subsides to a bearable ache or the tight feeling at the heel. There will be a definite tender zone on the inferior medial heel, which will almost never go away.
Who has to endure this burden?
Plantar fasciitis affects men and women on an equal level. Typically working adults between the age 25 and 65 are affected. Occuring in approx 10% of the population. Presenting bilaterally in a third of these reports. [2]
Activities that involve running, jumping, standing for long periods of time, will see more common occurrences for plantar fasciitis. Some studies and reports have found that runners can have a high prevalence. Particularly long distance running. Also feet reliant dancers, such as ballet performers experience high volumes of plantar fasciitis. [2][3][4]
‘You ought to not heal the body without the soul, for this is the great error of our day in treating the human body’ .. Plato
What causes Plantar Fasciitis?
While there is no single cause for plantar fasciitis. It can be a cause of some common factors. It may be due to one or more of the following reasons;
Degeneration, micro tears, collagen disarray, granulation of tissue
Heel Spur
Thickening of the plantar fascia
Unsupportive flat shoes
Naturally high arches in feet
Flat feet with weak arches
Overstretching of the sole of the foot and calf
Excessive body weight
Repetitive stress injuries
Diagnosing Plantar Fasciitis?
Plantar fasciitis can be clinically diagnosed. However imaging is not necessary. Unless you require extensive treatment and possible scans to further rule out other causes for the pain. A physical examination, palpation and special testing will often be sufficient for diagnosis of plantar fasciitis. Your health history and presenting symptoms will
be the valuable information in formulating a treatment plan, as well guide you for approximate time frames for expected improvements.
X-ray and ultrasound can rule out other injuries as mentioned. What they can show is the calcification of the heel, giving rise to heel spurs should they be present. Ultrasound can also show the thickening of the plantar fascia should this be present. MRI’s are utilised to scan for stress fractures, make tear evaluations and check for bone defects if required.
If treatments are not achieving progressive positive healing results then further investigation through scans and referral to specialists would be warranted. When I carry out care plans for plantar fasciitis I am constantly evaluating each session and follow up recovery days. This enables a consistent map of the healing process to be drawn; giving you the confidence to continue with your self care program.
You may be tempted to seek a corticosteroid injection. Which understandably will take the pain away. However, this will be short lived (3-4wks). It is not effective for long term results. Other therapies such as Electronic Shock Wave therapy (ESWT) are common, but deliver mixed results. Often being the case, it either helps or doesn't. Other injections can also be undertaken, such as prolotherapy, platelet rich plasma or botulinum toxin A. There is always with surgery being the last resort.
How will acupuncture and orthopaedic massage benefit your recovery?
Once diagnosis is confirmed then treatment should commence with a thorough plan incorporating an initial care plan that targets the pain cycle foremost. This is a self-limited condition. So with treatment intervention and self care routines. Symptoms should resolve quickly. Sometimes the condition can take up to 12 months to resolve in rare cases, even with conservative treatment. [2]
In a randomised controlled trial that consisted of 10 daily treatments over a 2 week (Mon -Fri) period with follow ups at 1, 3 and 6months (Zhang et al., 2011). It was observed that results indicated acupuncture is effective for plantar fasciitis pain relief. Furthermore the study provided evidence that specific acupoints (PC7 and LI4) on the hands provided analgesic and anti-inflammatory benefits. [7]
What I deliver is a combination of orthopaedic acupuncture, herbal medicine and soft tissue techniques. Designed to increase blood flow through the affected tissue. While alleviating any muscle hypertonicity that may be placing undue stress on the plantar aponeurosis. I do this while educating you on your condition and giving you home care routines to undertake between treatments.
Remember, plantar fasciitis is self-limiting and requires you to do most of the healing work!
Acupuncture alone retrains your brain how to heal the body again by directing essential nutrients through the blood to an area of your foot that struggles to receive fresh warm nutrient rich blood on the best of days. Herbal medicine supports the systems that permeate through the bone marrow development, organ maintenance, blood and collagen manufacturing, detoxification, cell regeneration and bone strength. Essential processes required for alleviating tissue damage, inflammation, repair and regeneration.
I'm upfront here. A care plan for plantar fasciitis will be from 10-15 sessions to start. With reviews along the way to assess progress. Initial acupuncture treatments will be carried out more frequently to initiate a healing change. This will also help you to start the homecare routine I train you for so it becomes habitual. I also incorporate musculoskeletal taping that relieves pressure from the affected heel. This will give you short term relief. But more importantly allow the affected tissues to start repair.
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PLANTAR FASCIITIS PAIN?
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You may be seeing other practitioners such as a podiatrist, osteopath or physiotherapist. This is all good, as a multi-faceted approach works well. You may require appropriate orthotics to be made or fitted with appropriate fitting shoes. Biomechanics will need to be addressed to ensure a return to activity does not cause a repeat of the plantar fasciitis.
The best plan while undertaking this treatment is to limit long periods of standing. Avoid excessive overstretching during physical activity. Lose excessive body weight if possible and incorporate structural arch supports into footwear. Regardless of the cause plantar fasciitis is not a degenerative disease you have to live with. It is easily reversible and managed if you stick with a treatment program.
A bit about me:
Dr. Jacob Hoskins BHSc Chinese Medicine, DIpREM
Dr. Jacob Hoskins is passionate about healing, results and helping others achieve the best out of their lives. Your movement without pain and restriction will give you confidence to carry on doing what you love doing. At Jacob Hoskins Acupuncture your whole health is taken into consideration to create ultimate healing steps towards longevity.
SOURCES
Australia, H. (2020, March 12). Plantar fasciitis [Text/html]. Healthdirect Australia. https://www.healthdirect.gov.au/plantar-fasciitis
Buchanan, B. K., & Kushner, D. (2020). Plantar Fasciitis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK431073/
D, S., C, G., K, P., R, D., & Jm, H. (2019, October 18). Effectiveness of Mechanical Treatment for Plantar Fasciitis: A Systematic Review. Journal of Sport Rehabilitation; J Sport Rehabil. https://doi.org/10.1123/jsr.2019-0036
Schwartz, E. N., & Su, J. (2014). Plantar Fasciitis: A Concise Review. The Permanente Journal, 18(1), e105–e107. https://doi.org/10.7812/TPP/13-113
Travell, J. G. (2019). Myofascial pain and dysfunction: The trigger point manual. Thnird Edition.
What to Know About Plantar Fasciitis. (n.d.-b). Healthline. Retrieved May 29, 2020, from https://www.healthline.com/health/plantar-fasciitis
Zhang, S. P., Yip, T.-P., & Li, Q.-S. (2011, February 15). Acupuncture Treatment for Plantar Fasciitis: A Randomized Controlled Trial with Six Months Follow-Up [Original Article]. Evidence-Based Complementary and Alternative Medicine; Hindawi. https://doi.org/10.1093/ecam/nep186