Striding towards recovery: The enigma of Plantarfasciitis and its comprehensive treatment protocols

Plantarfasciitis is a common cause for heel and arch pain, occurring when the plantarfascia muscle is irritated and inflamed. Since it is a widely prevalent issue with an etiology of 10%, its treatment protocols are vast and plenty.

However, how do we know what treatment options really work? The answer lies in the best available recent evidence and research!

Understanding the Anatomy and Biomechanics behind Plantarfasciitis

The plantarfascia is a thick, fibrous muscle that originates from the calcaneal bone (heel bone) and inserts into the small fascial structures of the toe joints.

Plantarfasciitis is an overuse injury that is caused by repetitive strain causing microtears in the plantarfascia muscle. This increases localised inflammation to the area, making the tissue degenerate overtime. Chronic plantarfasciitis (present for over 12 weeks) can present with thickening of the muscle, tears and loss of collagen.

Common causes for plantarfasciitis:

• Direct injury to the muscle

• Flat feet (pes planus)

• High arch feet (pes cavus)

• Limited ankle mobility

• Tightness of the gastrocnemius and soleus muscle (calf muscles)

• Internal Knee position

• Internal hip rotation

What does the research say?

Guided by pain level and how long the plantarfasciitis has been present, there a few protocols in place for those with acute plantarfasciitis.

Acute plantarfasciitis (0-4 weeks)- Early stages of podiatric management

• Compression sleeves

• Offloading and rest

• Ice/cold therapy

• Topical or oral antiinflammatories

• Deep friction release and massage of the arch and calf muscles

• Stretching and mobility rehab of the hamstrings, calf muscles and hip muscles.

• Orthoses and heel lifts.

• Footwear with appropriate arch support and a heel counter.

Chronic Plantarfasciitis (>4 weeks)- Medium term podiatric management

• Custom made orthotics

• Dry needling

• Extracorporal shockwave therapy

Non-responsive to conservative treatment

Usually, a referral to a podiatric surgeon or an orthopedic specialist is required if the plantarfasciitis is unresponsive to conservative treatment protocols. Injection therapy using platelet rich plasma has been shown to be effective in restoring collagen and elasticity to the plantarfascia. Other injection therapies such as cortisone and dextrose injections may also settle the inflammation and reduce pain levels.

How do I get treatment for plantarfasciitis?

If you have plantarfasciitis and you are wanting to get back onto your feet, an assessment by a podiatrist for further management is recommended. Depending on the duration of the condition, treatment protocol may vary from person to person.

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