Innovative Treatments for Plantar Fasciitis
SHOCKWAVE THERAPY AND PLATELET-RICH PLASMA (PRP)
Plantar Fasciitis, one of the most common sources of foot and heel pain, affects over one million people every year according to Medscape. The deep plantar fascia (plantar aponeurosis) is a thick tissue with longitudinal fibers that attach to the skin. Plantar fasciitis is characterized by pain in the plantar region of the foot - or the sole of the foot - that typically worsens when initiating walking.
RISK FACTORS / ETIOLOGY FOR PLANTAR FASCIITIS
Most occurrences are reported in people aged 40-60 years. While the etiology of plantar fasciitis is not well understood, it is likely multifactorial. Potential risk factors include flat feet, reduced ankle dorsiflexion, obesity, and prolonged standing or jumping.
Runners seem especially prone to plantar fasciitis due to injury caused by repetitive microtrauma. For runners, the following risk factors may contribute to their relatively high incidence:
Excessive training (particularly a sudden increase in longer distance runs)
Inadequate running shoes
Running on unyielding surfaces (including some synthetic running tracks)
Limited ankle dorsiflexion
Pes cavus (high-arched) foot
Flat feet (pes planus or pronated ankles)
Plantar fasciitis is also common among ballet dancers as well as those performing dance-based aerobic exercises.
EVALUATION AND DIAGNOSIS
Plantar fasciitis diagnosis is based on a reported history of inferior heel pain that appears to be more pronounced when initiating walking - plus the finding of localized tenderness. Many patients describe heel pain that is worse in the morning or following a period of inactivity. This pain typically decreases with increased activity but can worsen at the end of the day following prolonged periods of standing.
Laboratory testing is not helpful, or necessary, in the diagnosis of plantar fasciitis. Tests for inflammation are typically normal and radiographic assessments (i.e. x x-rays, MRI, or ultrasound) are not necessary for diagnosis, though they may be required to rule out alternative causes if symptoms persist.
TREATMENT OF PLANTAR FASCIITIS
In general, most physicians approach the treatment of plantar fasciitis by recommending the following initial measures:
Stretching exercises for the plantar fascia and calf muscles, which the patient performs at home
Avoiding the use of flat shoes or walking while barefoot
Using prefabricated, over-the-counter, silicone heel shoe inserts (i.e. arch supports and/or heel cups)
Decreasing physical activities that may be causative or aggravating (eg, excessive running, jumping, or dancing)
A prescription for a short-term trial (two to three weeks) of nonsteroidal anti-inflammatory drugs (NSAIDs). The use of NSAIDs can be helpful, however, their long-term use should only be reserved for patients with known systemic rheumatic disease.
Shockwave Therapy or PRP Therapy (see section below)
Injecting the tender areas of the plantar region with glucocorticoids and a local anesthetic
In severe, long-lasting cases, orthotics, night splints or surgery may be considered.
TREATING PLANTAR FASCIITIS WITH SHOCKWAVE THERAPY
While often effective, the treatment options listed above don’t provide relief to every patient. The Mayo Clinic states, “ESWT (Extracorporeal Shockwave Therapy) is a viable option to consider for many patients who present with chronic tendinopathy.” Additionally, according to an article in Medicine, “FSW (focused shockwave) therapy can relieve pain in chronic PF (plantar fasciitis) as an ideal alternative option.”
The use of shock waves was approved by the FDA in 2000 for the treatment of plantar fasciitis and has been widely used as an alternative treatment option due to its noninvasive nature and fast recovery time. Additionally, few complications have been reported with the use of shock wave therapy - as opposed to a surgical approach which may put patients at risk for continued pain, wound problems, and infection.
SHOCK WAVE THERAPY - HOW IT WORKS
During shockwave therapy, a special probe is used on top of the skin to deliver pressure waves to the affected area. These waves travel throughout the skin until they reach inflamed tissue where they trigger the body's natural healing process, causing new blood vessels to form. Oxygen and blood supply in the area are increased, resulting in the regeneration of healthy cells and improved healing times. The microtrauma caused by shockwave therapy also aids in the healing of connective tissue.
Studies seem to suggest that a “focused” shockwave device is more effective compared to “radial” shockwave for the treatment of plantar fasciitis. Our clinic is one of the few in the area to employ both devices for various issues - and we use the focused technology to treat plantar fasciitis.
The procedure is conducted in our office and is quick and easy - typically taking approximately four and six visits and resulting in most patients reporting a fairly immediate decrease in pain. There is no downtime - you’re in and out of the office in thirty minutes and can get back to your day.
PLATELET-RICH PLASMA (AKA PRP) THERAPY FOR PLANTAR FASCIITIS
PRP therapy has been used for decades by orthopedists to help professional athletes heal injuries. Because of its ability to regrow collagen, enrich fibrin, and aid in the formation of new blood vessels, today this therapeutic approach is increasingly used to regenerate ligaments, tendons, and joint injuries.
Platelet-rich plasma is prepared by drawing a patient’s blood and separating out and concentrating their platelets and growth factors. Once extracted, this healing and restorative plasma is then applied to and injected in targeted areas, causing a cascade of local factors to stimulate angiogenesis and regeneration.
One trial reported that a “Platelet-rich plasma injection is as effective as or more effective than corticosteroid injection in treating chronic plantar fasciitis.” Another trial comparing the results of local injection of platelet-rich plasma (PRP) and corticosteroids in the treatment of plantar fasciitis found that “both methods were effective and successful in treating plantar fasciitis. When the potential complication of corticosteroid treatment was taken into consideration, PRP injection seems to be safer and at least having the same effectivity in the treatment of plantar fasciitis.”