Ask the podiatrist: How can I treat persistent plantar fasciitis?

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Michelle says: I have had plantar fasciitis for years. Is there any treatment for it? I keep getting fobbed off by the doctors.

Hi Michelle, there are a large number of treatments for plantar fasciitis and therefore an equally large number of combinations of these treatments. Some of the treatments are supported by scientific and/or clinical evidence, others are supported by anecdotal evidence.

The first stage is to offload the forces that are causing the damage to the plantar fascia and its insertion into the heel bone. A temporary taping technique called Low-Dye strapping can be used for rapid offloading of force in the plantar fascia. This can be used prior to a running event or if you are going to spend a long time on your feet (a potential cause of plantar fasciitis). The tape can really only be used for two to three days at a time, after which it loses its effectiveness. Following this, elastic taping can be used for longer periods to give you position awareness of your foot and help reduce any swelling from inflammatory changes in the area. Also, reduce the amount of running that you are engaged in or even stop for a while until the pain reduces. Try alternative, non-weight bearing forms of keeping fit. Examine your footwear, as tight calf muscles seem to be a risk factor. Wear running shoes with a slight heel to sole height difference (called the ‘drop’ in running shoes) rather than flat ones – same with everyday footwear. Also, wear footwear with a cushioned sole. You may need to wear foot orthotics in your shoes (provided there is enough space).

Foot orthotics will help offload the forces going through the plantar fascia by initiating foot function that allows the plantar fascia not to function outside of its pain-free, normal physiological limits. Foot orthotics can be pre-fabricated or custom-made. Where pre-fabricated orthotics fit your foot, they will have the same effect as custom-made devices. In both cases, ensure that they have a cushioning top surface for comfort (damage to the heel fatty pad can also be a cause of plantar fascia pain).

Stretching the plantar fascia and the Achilles tendon is very important throughout the day for offloading the plantar fascia, and include calf muscle and hamstring stretches as well. Using a cooled rolling device (such as the Carnation Footcare Pediroller) beneath the plantar fascia at least three times per day is strongly recommended for stretching until the pain has decreased. Also, the use of night splints is recommended to place a low grade stretch through the plantar fascia and Achilles tendon. These can be in sock form (Strassburg sock) to reduce the inconvenience of wearing this device in bed.

The second stage is to gradually return to the activity level that you desire by allowing the plantar fascia to accept the loads that it will be faced with during running. While returning to your desired level of running, continue to wear any orthotics in your shoes, continue to stretch the plantar fascia and Achilles tendon and reduce the risk factors that are associated with overloading it. The recognised risk factors are a BMI ≥ 25 kg/m², standing on your feet for more than eight hours a day and reduced ankle joint dorsiflexion (i.e. your ankle joint has a range of motion less than that which is required for walking and running in order not to excessively load the plantar fascia. Also feet that pronate (roll in) beyond the point in gait where they should stop (excessive pronation) should be controlled, as previously mentioned with foot orthotics. Ensure, at this stage that you address your core stability musculature as an altered pelvic position can place increased load at the heel region.

Lastly, the plantar fascia should be facilitated to heal with a balanced diet to allow biological reconstruction to the damaged tissue. Non-steroidal anti-inflammatory medication can be used if pain becomes very uncomfortable. Long standing pain can be treated with Extra Corporeal Shock Wave Therapy which stimulates local inflammation and tissue healing. Radiofrequency microtenotomy, Micro-Mobile Compression and platelet-rich plasma injections are emerging therapies that assist healing but are not widely available.

Michael Ratcliffe is a podiatrist and advisor for Carnation Footcare.