Does plantar fasciitis need a magic wand to cure or shall we let science do the job?
(I vote science)
How do we treat it?
We know that plantar fasciitis is characterised by irritation and inflammation caused by tension and stress on the plantar fascia, which can be brought on by poor foot mechanics.
So…
Let’s break the treatment down to addressing exactly those things.
There are 3 main treatment modalities that are proven to treat plantar fasciitis and you may need a combination or all 3 for success.
- Custom Orthotics
- Shockwave Therapy
- Stretching Exercises
There are lots of other things that you can do that won’t necessarily get rid of plantar fasciitis but will certainly help the symptoms. We know that plantar fasciitis can sometimes be extremely stubborn so we recommend attacking it from all angles.
Will plantar fasciitis go away on its own?
It is unlikely to go away completely without professional treatment. You may get occasional respites from the pain but it is likely to keep popping up and can lead to longer term issues.
Custom Insoles for Plantar Fasciitis
There are many biomechanical issues that can be an underlying cause of plantar fasciitis. These can include:
- Overloading of the inner border of the heel due to laxity, stiffness, internal rotation of the leg.
- Problem with the function of the 1st big toe joing which means an important mechanism called the ‘windlass mechanism’ doesn’t happen effectively.
- Lack of supination of the foot meaning the foot is always in its ‘flexible shock absorbing mode’.
So by carrying out a thorough clinical examination and gait analysis we can pinpoint these issues, prescribe a pair of foot orthotics and address the condition from the underlying issue. We are not talking about an arch support – usually the arch is not the problem. Having a low arch or a high arch is a bit like having blonde or brown hair. It’s how the arch functions around the rest of the structures in the foot that is crucial.
Shockwave Therapy for Plantar Fasciitis
Once we have corrected any biomechanical issues, or if there are none in the first place, shockwave therapy is a highly successful treatment for plantar fasciitis. It involves delivering sound waves into the body using a special handset which triggers the body’s own inflammatory response, allowing the body to heal itself.
It is completely non-invasive with minimal side effect and almost anybody can be treated with shockwave therapy.
The treatment is approved by NICE (National Institute for Care and Excellence), the FDA (US Food and Drug Administration) and is widely documented as a proven treatment for plantar fasciitis.
It does not carry the same risks as corticosteroid injections such as fascial rupture, fat pad atrophy, thinning of the skin, and in many cases it is shown to be more effective long term than steroids.
Stretching Exercises for Plantar Fasciitis
The plantar fascia is a little like an elastic band and constantly stretches and relaxes during gait. This can cause micro tears at the attachment to your heel bone leading to irritation and inflammation. So by regular stretching of the plantar fascia, we can reduce the strain at this attachment.
We also tend to rest and sleep with our foot in a plantarflexed position (pointing down) which relaxes the ‘elastic band’. When we then place the foot on the floor we get an instant sudden stretch which can often cause intense pain.
Stretching exercises for plantar fasciitis can be anything that brings your foot towards your shin, but tailored exercises are a better idea. And when you are suffering from plantar fasciitis these exercises need to be done Every. Single. Day. No excuse. They will help, but not if you only do them when you remember, or just before you go to see your clinician for a review.
Other Self Help Treatments
These things will not take away the condition but can really help with the symptoms and make life a little more comfortable for you.
Night Splint
Holds the foot in a 90° position, keeping a gentle stretch on the plantar fascia overnight. Really helps reduce that initial morning pain when you first get out of bed. It can also be worn when relaxing, again to maintain a slightly stretched position.
There are many types of night splint but the best kind are large, rigid and pass up the back of the leg and under the foot. The sock type are known to be uncomfortable at best, and slip down, and also don’t provide enough of a pull to stretch the foot.
Rolling a ball under the foot
You can roll a tennis ball, a bottle, a can, anything under your foot, which will give you a soothing massage effect. Even better you get use specific devices which have ridges or spikes to increase the effect. Many of these can be put in the fridge or freezer too.
Massage
Having somebody massage your foot can be very relieving, although you will need to guide the person on how much pressure you can tolerate. Sometimes just working the plantar fascia in the arch area can be enough, whilst avoiding the point where it attaches to the heel bone which can be too painful.
Anti-Inflammatory Gel
These gels and creams can be bought from any chemist without a prescription but the results do vary significantly. Some people get some relief but for some, the gel isn’t able to penetrate the foot deep enough to give any effect.
Watch your sitting position
If you sit on a chair at work, try sitting with your feet flat on the foot so your knees and ankles are both at 90°. This will maintain a slight stretch on the plantar fascia so when you stand up it shouldn’t be quite so uncomfortable. Try not to sit with the weight resting on your toes or with your feet and toes stretched out in front of you.
