Review of Current Therapeutic Options for Management of Plantar Fasciitis
Foot pain is a very common complaint among people in the United States. Plantar fasciitis, a very painful condition of the heel, is the most common cause of heel pain. Around two million Americans experience plantar fasciitis every year. The cause is the inflammation - and pain - of a thick band of tissue that runs across the bottom of your foot, the plantar fascia. The plantar fascia, which isn't very flexible, is what connects your heel bone to your toes. Because it isn't flexible, it's pulled on (tension) if every time you flex your toes, or the toes are pointed upwards. This happens when you walk, particularly with high heels, for example.
Constant stretching and pressure can result in inflammation of the plantar fascia, which results in plantar fasciitis. Risk factors for plantar fasciitis include hurting your heel or under the foot (trauma, stress), as well as repetitive use, like runners do, but even others who are on their feet a lot are at higher risk.
When going to the doctor, in order to diagnose plantar fasciitis, your history is important. You will also be examined and your doctor will likely watch how you walk. You'll be asked about the type of pain, because plantar fasciitis pain is typically a sharp shooting pain that is relieved with activity and may become more like a dull ache by the end of the day. It hurts more first thing in the morning or if you've not been on your feet for a while.
While the doctor may suspect plantar fasciitis, he or she has to rule out a few other foot problems first. These include the foot's equivalent of carpal tunnel syndrome, called tarsal tunnel syndrome, problems with the nerve being trapped near the plantar nerve, fractures, masses, or another problem called central heel pain syndrome. If necessary, your doctor may order some tests, such as x-rays while you're standing (called weight-bearing x-rays), bone scans, or even magnetic resonance imaging (MRI) or ultrasound.
Treatment for plantar fasciitis is first usually nonsurgical. The most successful nonsurgical treatment so far has been stretching the Achilles tendon, the tendon that connects your heel to the leg. This can be done with special exercises or with splinting. Exercises can be done any time anywhere, so these are often the first choice treatment. Night splints are a popular choice for treatment too and, according to studies, help relieve up to 80 percent of the foot pain. But, many patients don't like the inconvenience of wearing the splint or can't afford to buy it.
Foot inserts into the shoe, called orthotics is another approach. This can be done alone or with the exercises. Researchers aren't so sure of their effectiveness though. Research seems to show that although there are improvements with orthotics over the first few months, after a year, there doesn't seem to be any advantage to them.
Medications may be tried to help relieve the inflammation and thus the pain. Anti-inflammatory medications can be given by mouth, used as a cream, or as an injection directly into the fascia. Research hasn't really found any strong benefits to these treatments, but they could be useful with splinting.
From what sounds a bit like science fiction is another treatment called extracorporeal shock wave therapy. This therapy involves aiming shock waves to hit the fascia, although doctors aren't quite sure how it works. The treatment does seem to be effective, but is recommended to be used after some of the other treatments have been tried first. One advantage to the shock wave therapy is there seem to be few complications, so this may be a treatment option for considering surgery, which is the next step.
If no other treatment has helped relieve the pain of the plantar fasciitis, surgery may be the only option left. The problem with surgery is two-fold. The first is the risk of surgery. As with any surgery, there are risks of infections, difficulty healing, and so on. The second is that most studies didn't find that surgery helped very many of the patients.
The authors of this article conclude that the nonsurgical treatments are the traditional and mostly used treatments for plantar fasciitis. They point out that stretching can play a key role in therapy and seems to be quite successful for many patients.
David W. Schippert, et al. Recent Updates in the Management of Plantar Fasciitis. In Current Orthopaedic Practice. April 2009. Vol. 20. No. 2. Pp. 130-135.