Plantar Fasciitis Help
Getting to the Source of Plantar Fasciitis
Dr. Jason Kremer works with a spectrum of musculoskeletal compaints and sports injuries in Bend Oregon. If you've stumbled accross this blog, chances are you're already familiar with the diagnosis of your unbearable foot pain- Plantar Fasciitis. Plantar fasciitis is a degenerative condition of the foot in which repetitive trauma causes the connective tissue of the plantar fascia to breakdown. Pain is often noted on the medial side of the bottom of the heel and is often worse when first getting out of bed or after sitting for long periods.
Here are some interesting facts on this condition:
- 44% of individuals with plantar fasciitis will still have pain 15 years after the initial diagnosis
- The most recommended treatment protocols- including orthotics, steroid injections, and stretching have not shown to be successful regarding long-term outcomes
- Weakness in the lower leg and foot (peronel muscles and intrinsic arch muscles) are a primary risk factor for chronic plantar fasciitis
- Tightness in the medial head of the calf (gastrocnemius) is strongly correlated with chronic plantar fasciitis. A specific streching routine has more recently shown to lengthen the medial gastrocnemius by structurally changing its muscle fibers.
This is a condition I see quite often in my practice, and sadly, patients have already been suffering from it for quite some time before seeking care. I've also seen several cases that have just not responded to other treatments or interventions such as orthotics. Recent research confirms that neither high nor low arches have any correlation with the development of plantar fasciitis. Traditionally, it has often been recommended to address "over pronation" with orthotics which has been shown to give some temporary relief but still does not address the underlying problem. Long term effectiveness of orthotics has never been proven. This also leads to the significant weakening of the deep intrinsic muscles of the foot and arch, which further creates a dependancy on the orthotics.
Another common treatment for plantar fasciitis is corticosteroid injections. This is intended to treat the "inflammation", however, a 2017 meta-analysis evaluating the effectiveness of steroid injections only showed to slightly improve symptoms in the first four weeks but not thereafter. The conclusions of this literature were not surprising because for over 20 years now, research has consistently shown that plantar fasciitis is a chronic "degenerative condition", not an inflammatory reaction.
If you've been dealing with acute or chronic plantar fasciitis or you've delt with this notorious condition in the past, I recommend you start off by making calf stretching a priority and start working on building the strength of your peroneal and intrinsic foot muscles. Again, this is an area I work with a lot and see a great deal of success in patients who follow through with treatment and home exercise protocols. Based on physical examination, we commonly perform lumbar, pelvis, hip, foot and ankle adjustments in conjuction with more in depth corrective exercise prescriptions, Graston technique, myofascial release, kinesiotaping, and in more complicated cases- therapeutic ultrasound.