Plantar Fasciitis Fact Sheet

Man in pain holding foot with plantar fasciitis

Heel pain centres in Sydney, Brisbane and Melbourne studied, researched and treated 10,000+ patients over 15 years. During that time all known treatments were assessed and analysed for efficacy. Conclusions displayed hereunder are based on that database. Supported by external references.

Plantar Fasciitis

Plantar Fasciitis is a strain or micro-fibre tear of in-elastic (ref 8) fibrous tissue attaching at the forefoot and inserting into the calcaneous (heel bone) like an anchor point. This tissue is a major stabiliser of foot arch support. The fascia also has very little blood supply.

The Plantar fascia is not Ligament, Tendon or Muscle.

Data has conclusively shown that long term plantar fasciitis is a weight bearing functional problem with foot structure causing bodyweight on standing and propelling forward, overloading fibres.Our

Plantar Fasciitis Pain Anatomy

Current Treatments being applied in 2021

Arch Supports and Orthotics

After years of prescribing arch based orthotics the Heel Pain Centre concluded arch lift is potentially a contributing factor in prolonging and some cases aggravating fascial tears. A Mediolongitudinal arch support is often not tolerated in a patient with plantar fasciitis as it pushes up on the plantar fascia and increases tension on its fibres. (ref 8)

Anti-inflammatories

Treats pain symptoms and may help to take the edge off early intense pain. Research has shown that Fasciitis is more of a Fasciosis, meaning a lack of inflammatory cells would indicate little possible benefits and the same could be said of corticosteroids. (ref 5)

Stretching

A gentle relaxing calf muscle stretch will help to limit tension on the Fascia during gait. But, aggressive step stretches, calf raises etc.. will aggravate inelastic fibres. (ref 1)

Heat

Increases blood supply which in turn increases inflammatory markers and soft tissue swelling. There is minimal blood supply in the fascia, hence surrounding region becomes swollen.

Camboots

Old therapy more in line with damaged bones, joints and torn soft tissue to immobilise in short term. Long term can lead to weakening and the atrophy of lower limb muscles as well as imbalance in hips and pelvis.

Ice Bottles

Rolling feet over bottles or cans of frozen water aggravates the Plantar fascia tissue as the weight of the leg is bearing down on the microfibre tear. The plantar fascia cannot stretch.

Footwear

Footwear: Soft, flat, flexible, light spongy footwear and bare feet will increase the downward and inwards pressure and aggravate any tear. This form of footwear also allows excessive flexing of the forefoot increasing the pulling effect on the in-elastic fibres

Massage

Calf muscle relaxation and massage is beneficial in early stages (1-6 weeks). But, massaging the fascia with golf or tennis balls etc… will increase tension in the tissue. The fascia is not a muscle or tendon.

Taping

Taping provides only transient support, with studies showing that as little as 24 minutes of activity can decrease the effectiveness of taping significantly. (ref 6, 7)

Acupuncture

For this ailment no scientific evidence of benefits for fascia, but may assist pain.

Cortisone (steroidal) Injections

Treats pain symptoms by blocking the body’s ability to produce inflammation. Recently some worldwide rejection to its use on weight bearing ailments. Can lead to fat pad atrophy, weakened of plantar fascia and tissue rupture. (ref 9, 10)

Shockwave Therapy

Primarily and historically used to break down Kidney stones. Can help thickened scar tissue and promote new growth.12 But does not address the prime load bearing cause on the plantar fascia, therefore allowing continuous repetitive micro-trauma. (ref 13)

Side effects, risks of tissue damage.

Blood Injections PRP

Blood Injections PRP: At present poor results from research. Platelet-rich plasma is used to provide pain relief and encourage soft tissue repair. But this is just symptomatic treatment. (ref 14)

Surgery

Formally used to remove heel spurs. Removal of the spur is not warranted, as stated4 the bony spur is not in the same layer as the PF. The plantar fascia is one of the main stabilisers of the foot arch during the propulsive phase of gait. Cutting the fascia may lead to a “foot drop” foot type. Research suggests avoidance of plantar fascia surgery wherever possible. (ref 10, 11) 

Contact the PF Clinic for more information

Contact us today and we’ll arrange for a specialist to discuss your ailment and treatment plan.

References

1). Hicks J.H. The Plantar Aponeurosis and the Arch. J. Anatomy 88:25.  2) Sarrafian F.K. Functional Characteristics of the Foot and Plantar Aponeurosis under Tibiotalar loading. Foot and Ankle; 8:4.  3) Khan K.M, et al. Histopathology of Common Tendonopathies. Update and implications for clinical management. Sports Med. June; 27(6): 393-408.  4) Barrett S.L. Endoscopic Heel Anatomy: analysis of 200 fresh frozen specimens. J. Foot and Ankle Surgery; 34: 51-56.  5) Khan Et Al. Time to Abandon the Tendonitis Myth. BMJ Mar 16 2002; 324(7338): 626-7.  6) Lohrer H, Alt W, Gollhofer A. Neuromuscular properties and functional aspects of taped ankles. Am J Sports Med;27: 69-75.  7) Manfroy PP, Ashton-Miller JA, Wojtys EM. The effect of exercise, prewrap, and the athletic tape on the maximal active and passive ankle resistance of ankle inversion. Am J Sports Med;25: 156-63.  8) Baxters, The Foot and Ankle in Sport. 2nd edition, Mosby 2008; 226-239.  9) Acevedo JL, Beskin JL. Complications of plantar fascia rupture associated with corticosteroid injections. Foot and Ankle Int;19: 91-97.  10) League AC. Current Concepts Review: Plantar Fasciitis. Foot and Ankle Int. 2008; 29: 358-366.  11) Murphy GA, Pneumaticos SG, Kamaric E et al. Biomechanical consequences of sequential plantar fascia release. Foot and Ankle Int; 19: 149-152.  12) Fink B.R. Management of Plantar Fasciitis Evolving. J Musculoskeletal Medicine. 2012; 29: 16-20.  13) O’Connor C. Heel Clinic. 2017  14) Cutt S, Obi N, Pasapula, Chan W. Plantar Fasciitis. Ann R Coll Surg Engl. 2012;94: 539-542.  15) Goodworth AD, Kunsman M, DePietro V, LaPenta G, et al. Characterization of how a walking boot affects balance. J Prosthet Orthotics. 2014; 26(1):54-60.

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