Current Symptomatic Treatments
Over many years, the Heel Clinic has studied hundreds of patients and the following list of typical treatments are explained, based on these patient case histories. The current treatments commonly offered generally follow the sequence below. Due to the misdiagnosis of Plantar Fasciitis for over 25 years, nearly all these treatments either aggravate or have little effect on the ailment.
X-Ray:
Patients are invariably referred for an X-Ray or Scan to determine calcaneal spur growth. The results of X-Rays may indicate spur development, but this is already an incorrect diagnosis. Spurs are stimulated by pain, they are not part of pain.
Rest:
The only way to fully “rest” the foot is stop all activity
for 8-10 weeks. This obviously is completely impractical for most
people and generally is only short term relief.
Anti-Inflammatories:
Generally helps most patients for short periods in the early stages,
but does not address the root cause i.e. the structural
load on the Plantar fascia. But may help if the foot is well
supported. Anti inflammatories, like cortisone, are a mask, not a cure.
Calf Muscle Stretches:
Can often resolve early stages of mild tearing, but after 3-4
weeks with no improvement patients give up and believe there is
little benefit in continuing.
Stretching techniques can also aggravate fascia if applied
incorrectly i.e. step stretches, pulling toes back, tennis/golf
balls under the arch etc.
Massage:
Our experience indicates light gentle massage in the first 2-3 weeks at the onset of Plantar Fasciitis can be beneficial. As the pain intensifies, direct massage of the
plantar fascial attachment region will aggravate and can cause
intense pain. It is a tight ligament not a muscle. Rolling the ligament over golf balls tennis balls, wooden rollers etc., will only aggravate the injury.
Cushion pads:
A little short term relief,
but no long term benefits.
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Cortisone: Cortisone being a powerful anti-inflammatory appears to give relief by reducing the inflammation. Comments from hundreds of patients indicate it only lasts for a very short period and the pain is worse once cortisone wears off. Of course being a steroid the well known side effects should prevent further usage. Our experience indicate patients believe they are cured if they cannot feel the pain after the injection. The long term problem is they return back to their daily routines and exercise. During this time there is continued excessive tension and fibrous tearing at the calcaneus insertion. More and more doctors have ceased giving cortisone injections for plantar fasciitis. |
Shoes:
Supportive shoes with an elevated heel [like joggers] will help,
but not cure. Any flat, soft, spongy shoes, thongs or barefoot
increases the tension on the Plantar Fascia. Pain can be intensified
by the patients’ footwear choice in and around their
home, as well as in the workplace.
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Arch supports/Prescription Orthotics:
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Ice:
Compulsory for daily reduction of inflammation. But
rolling the foot on frozen cans or bottles of ice, will aggravate
the ligament. Patients
cannot control leg weight after 1 or 2 minutes and hence apply
further pressure downwards on
the Plantar Fascia. Ice packs help, but tend to warm up quite quickly.
Heat:
Increases
inflammation at insertion point by attracting blood to the region.
In this regard Plantar Fasciitis is no different to any sporting
injury.
Shock Wave Therapy :
This treatment consists of sound waves being directed to the region
of pain to stimulate healing by breaking up the spur. Studies have shown limited success,
with some instances of pain, swelling and bruising of the skin.
This treatment still does not address the structural cause.
Surgery:
After discussions with numerous surgeons the general agreement
is that surgery is not an option. Plantar fasciitis returns and
removing the spur is not treating the ailment. Patients can be
off their feet for up to 8 weeks for little or no benefit.
The
First
Medical visit:
Nearly all patients visit a local doctor first. Heel spur syndrome
/ Plantar Fasciitis is identified with varying degrees of explanation.
An X-Ray is usually recommended and this may or may not indicate
Calcaneal spur growth. At this first visit
Plantar Fasciitis is not always correctly explained. Spur growth often becomes the
basis of the treatment. Rest and anti-inflammatories are prescribed at this time.
Ceasing sports and activities:
Very frustrating for patients who particularly wish to lose weight.
Certain quick movement sports such as Tennis, Soccer, Squash,
Netball and Touch football etc put enormous stress on the Plantar
fascia as the forefoot is bent and flexed. Golf also is very
stressful due to the 4-5 hrs spent on your feet on undulating
surfaces. Walking or running on beach sand can actually cause
the initial tear. Unfortunately running activities applies 3-4 times
body weight equivalent load as well as the tension caused by
flexed ‘take off’. Currently, Gym treadmills are
one of the most common causes of plantar fascial tears, as they are elevated, ie, walking/running uphill.