Dr. Brandon Buchla, DC, CSCS
To start, I think it’s important to clarify one of the biggest misnomers out there. Plantar fasciitis should really be called plantar fasciosis. Evidence has shown that this condition is not an inflammatory process (as an “itis” is), but rather a degenerative condition (an “osis”). It’s a big distinction to make when thinking of how to treat it. Now plantar fasciosis is the most common cause of heel pain, and occurs when the plantar fascia (a thick band of connective tissue that runs from your heel to your toes) becomes degenerated. This pain is especially bad upon waking up in the morning, after the fascia has tightened up overnight. Although still unclear as to what exactly causes this degeneration, possible risk factors include micro-tears from overuse, improper gait mechanics, or just as a consequence of natural aging (seeing as the most commonly affected patient population is in middle-aged individuals).
To treat this condition, it’s again important to remember that it’s not an inflammatory condition but a degenerative one. As such, anti-inflammatory supplements/medications are not the way to go to directly treat this. Effective routes should be directed at countering the perceived causes. If it’s believed to be caused by overuse, then simple calf stretches and rest might be the best way. If it’s improper gait, or extreme supination or pronation (affects both equally) that’s a clear issue, then gait training or switching shoes / using orthotics could play a role in recovery. Staples of any treatment plan should also include myofascial release techniques and strength training, such as rolling the plantar fascia on a lacrosse ball, instrument-assisted soft-tissue techniques such as Graston/Smart Tools, dry-needling, and rehabilitation exercises. Now if you are someone who has absolutely exhausted conservative treatment for treating plantar fasciosis and have been disabled due to the pain, then there’s always other non-conservative routes. Although this only applies to a small population of affected individuals, shockwave therapy, platelet-rich plasma injections, and surgery can be used to help relief the pain. Everyone will experience this condition in a different way and respond differently, so what works for one person might not do anything for someone else. It’s worth understanding all the treatment options available and make educated decisions on what’s the best route for you!
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Written by Dr. Brandon Buchla, DC, CSCS
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