What Is Plantar Fasciitis and How Is It Treated?

Scott Densley

August 1, 2019

PTA146S – 10 Musculoskeletal-Orthopedics

What is Plantar Fasciitis and how is it treated?

 What is Plantar Fasciitis (PF)?  You may have heard Plantar Fasciitis being deemed or  associated with heel spur syndrome, plantar heel pain syndrome, painful heel syndrome.¹  “Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).”²  PF is usually diagnosed and common with runners, but can also be related to those that are obese.² Stabbing pain is a characteristic that is related to PF and is at its worst in the morning when weight bearing and early ambulation.² The pain can eventually subside with time, but without the proper support, substantial periods of standing, and after exercising, the condition can become evident once again.²  The anatomy to PF is essentially inflammation of fibrous tissue (plantar fascia) on the bottom of the foot that extends from the toes to the heel.²  The best way to describe plantar fascia is to know that it “acts as a shock absorber bowstring, supporting the arch of the foot.  If tension and stress on that bowstring becomes too great, small tears can arise in the fascia.  Repetitive stretching and tearing can cause the fascia to become irritated or inflamed, though in many cases of plantar fasciitis, the cause isn’t clear.”²  However, the risks of PF include the older generation, primarily the ages ranging from 40-70.^2,3,5,Pes Planus, limited ankle dorsiflexion, reduced ROM in the ankle and first metatarsophalangeal joint.²  Excessive pronation is another factor to consider when addressing individuals with PF and foot deformities in general.²

 PF results from repetitive trauma to the plantar fascia and is known to impact millions globally.⁴ In fact, the United States has reported around 2 million to be affected.² Plantar fasciitis is the leading cause of heel pain with 10% of patients dealing with this ailment for the majority of their life and is responsible for 11-15% of symptoms involving the foot.²  Again, with no clear cause, a variety of treatments and modalities have been used to treat this condition and each have had their own clinical response.¹ 

In regards to treating PF, several options can be prescribed.⁴  Some methods studied have deciphered better ways to treat plantar fascia with some providing better results than others.⁴  These options include, but are not limited to, Myofascial Release Technique (MFR), static stretching techniques, dry needling, orthoses, night splints, steroid injections, taping, laser therapy, anti-inflammatories, acupuncture, ultrasound, Estim, chiropractic therapy, extracorporeal therapy, MRI, soft tissue massage and ultimately surgery.^2,4,6  

Discussion in this paper will be more specifically related to the MFR technique, stretching, surgery, MRI, taping and ultrasound.^2,3-4  A Magnetic Resonance Imaging (MRI) can be a vessel to incorporate within this diagnosis.³  Why? The imaging offered is one of the most sensitive imaging equipment offered.³  This equipment has its advantages in that it can identify changes with neighboring soft tissues or bone marrow and can help medical experts with the extent and exact location of the inflammation.³  This benefit includes the understanding of the thickness, fluid-sensitive sequences and inflammation to the soft tissue and bone marrow of the plantar fascia.³  Ultrasound is a financially effective and common modality used to control pain, inflammation and can regulate quick results to improve function.^3-4 

The MFR is a pressure technique that is known as a manual technique that allows healing by fibroblast proliferation with the results of increased lymphatic drainage and blood flow and provide a distraction to restricted tissue.⁴  In fact, based on the Foot Function Index and the visual analogue scale, MFR showed better results than with stretching.⁴ The PreOperative 5.2 mean to PostOperation 2.3 VAS difference in MTR was a significant improvement to a 5.8 Preop mean to 3.89 VAS difference in stretching.⁴  Both techniques showed effectiveness for PF but MFR has provided better results.⁴  No evidence has been offered, but it’s believed in theory that MFR also hydrates dehydrated tissues and because of that, it helps with overall ROM.⁴  The effectiveness proven to stretching would also result in strengthening, increasing flexibility and reducing stress to the foot.⁴  Another technique provided to PF patients is taping and it simply assists with the muscular activity and promotes healing with the protection ofeach dynamic or static movement.⁵ 

When interventions or the conservative approach to treat PF fails, surgery is an option to provide relief.⁶  During a recent study, a surgery called fasciotomy is considered to remove that stress and pressure by cutting the fascia.⁶  It’s been determined that 5 % of patients don’t find relief from the interventions mentioned and that is when a fasciotomy should be considered.⁶  The results from the surgery were encouraging and based on the AOFAS scale based on pain, function and alignment.⁶  The postoperative score improved from 43.56 to 83.33 and 75.6% of heels evaluated experienced minor to no pain.⁶  Patients improved in means of pain and function proving that surgery can be a safe procedure and alternative option if all else fails.⁶

PF doesn’t discriminate by gender and is a serious impairment of foot deformities ranging from sedentary to active lifestyles.¹ Several case studies have been performed to determine the best approach to treat PF but with no real cause that makes things difficult.¹  A conservative approach would be to perform appropriate stretches to the Achilles and plantar fascia to help lengthen the muscles while improving flexibility and decreasing stress.¹  An MRI helps begin the process by determining the exact location of inflammation to the plantar fascia.³  By performing ultrasound therapy to promote healing to improve blood circulation and decrease pain has been beneficial when performing treatments.^3-4  Those treatments can include MFR that release restricted tissues and stress from the trauma to the plantar fascia that can create those tears.⁴  PF can become a significant issue and shouldn’t be pushed aside.²  When treatments do not manage your symptoms, surgery can be a topic of discussion.⁶  Surgery is a feasible option with early results of managing pain and provide function without changing your gait or posture to alleviate pain that can ultimately lead to other issues involving your hips, knees and feet.²

References:

1. Gurmeet Singh Sarla.  Treatment Modalities of Planter Fasciitis:  A Two Years’ Experience.  Research & Reviews:  Journal of Surgery.  2018;7(3):  21-23p.
2. Plantar Fasciitis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846.   Published 2018. Accessed July 31, 2019.
3. AbdKadhim M, Al-deen NJ. Ultrasound and MRI Findings in Patients with Planter Fasciitis. American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS).  https://asrjetsjournal.org/index.php/American_Scientific_Journal/article/view/4914. Published 2019. Accessed July 31, 2019.
4. Satish C. Pant, Dr. Dheeraj Lamba, Ritambhara K. Upadhyay, Dejene Kassahun.  Effect of Myofascial Release and Stretching Exercise on Plantar Fasciitis-A Randomized, Comparative Study.  International Journal of Current Research.  http://www.journalcra.com/sites/default/files/issue-pdf/30912.pdf.  Published 2018. Accessed July 24, 2019.
5. Natalia Sanchez, Brayan F. Contreras, Jose M. Garcia, Ruben D. Hernandez, Oscar F. Aviles.  Plantar Fasciitis Treatments:  A Review.  International Journal of Applied Engineering Research. http://ripublication.com/ijaer18/ijaerv13n17_39.pdf.  Published 2018. Accessed July 24, 2019.
6. Huyer RG, Bittar CK, Carlos Daniel Candido de Castro Filho, Mattos CA, Cillo MSPde, Ribeiro JHT. Outcomes of plantar fasciotomy to treat plantar fasciitis. Scientific Journal of the Foot & Ankle. https://scijfootankle.com/ScientificJournalFootAnkle/article/view/899/1043. Published 2019. Accessed July 31, 2019.