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Saturday, August 2, 2014

Plantar Fasciitis: Top 10 Treatments

The top 10 common treatments for plantar fasciitis:

1. Plantar Fascial wall stretch for 30 seconds 5-10x/day
2. Rolling ice massage 2-3x/day for 5 minutes (see discussion below)
3. No negative heel stretches
4. Avoid barefoot walking (something like dansko sandal at home)
5. OTC or custom orthotic devices to transfer weight into the  arch

6. Physical therapy or acupuncture (2x/week for 4 weeks and then re-evaluate)
7. Posterior sleeping splints when morning soreness over 5 minutes
8. Low dye/arch taping daily initially and then with strenuous activity
9. Activity modification to avoid “bad pain”
10. Calf stretches (straight and bent knee) 2x/day

This can be such a stubborn problem that it is easy to get very frustrated. Very few people need surgery for this since there are so many options for treatment. I once did a thorough review of the literature and found easy 72 different treatment options.  These treatment options are so numerous that we are normally limited only by our time and imaginations to develop a successful treatment plan. Each week there should be improvement once active treatment begins. If improvement plateaus, make a change. Analyzing what is working and what is not working should be part of the process.
Deal constantly with the 3 areas of treatment---anti-inflammatory, stretching or flexibility, and mechanical support (transference of pressure from the painful areas to non-painful areas). Most cases of plantar fasciitis need simple solutions like daily icing (anti-inflammatory), plantar fascial and achilles stretching 3 times daily (flexibility), and arch support (either custom orthotics or store-bought arch supports). Some more stubborn cases of plantar fasciitis need the above along with physical therapy to improve flexibility and anti-inflammatory measures, custom-made orthotics if not already manufactured, night splints to gentle stretch out the plantar fascia, cortisone shots if a bursitis under the heel bone is found, and many other options.
In resistant cases, 3 months in a removable cast can help calm down the inflammation. The moral of the story with plantar fasciitis is never give up. Keep trying to find the right combination of anti-inflammatory, flexibility, and mechanical support. Also remember that 25 to 30% of all cases I see for plantar fasciitis for a second opinion, have something else. Neuritis, bursitis, stress fractures, all head the list in the differential diagnosis.

Dr Rich Blake and the Center For Sports Medicine Singing Group (aka Richie and the Saints) from Saint Francis Memorial Hospital in San Francisco sing " I Want A Hippopotamus For Christmas" at a Christmas Bash. Since there are hardly anymore record stores, see if iTunes is selling it.
Here the MRI section is a little closer to the heel bone showing some greater inflammation settling under the heel (called bursitis). Again, no tear is noted but in both views the plantar fascia would be considered thicker than normal from scarring. The health care provider must treat the intense inflammation initially before actual work can begin on the thickened plantar fascia (this is where ART or Graston shines--Active Release Technique--not colored crayons and ceramic bowls)

This is a great MRI scan showing intense inflammation around the plantar fascia just in front of the heel bone. The pain was so severe the MRI was done to rule out a tear in the plantar fascia or a calcaneal (heel bone) stress fracture. With the MRI you can look at the plantar fascia in all 3 body planes to make sure you are not missing anything.

Plantar Fasciitis or Plantar Heel Bursitis: Rolling Ice Stretch

    The Most Time-Effective Treatment for Plantar Fasciitis is a 5 minute Rolling Ice Stretch. It combines anti-inflammatory, mechanical massage, and plantar fascial stretch all beneficial in helping plantar fasciitis. If there is a plantar bursitis, an additional 5 minutes of massage just to the bottom of the heel is performed. A plastic bottle of any shape (patients do have their favorites) is filled 1/2 to 2/3 full of water and then frozen. The water will expand with freezing. Then, a towel is placed on the ground, and from a sitting or standing position (I personally like standing but not with full body weight), the arch from heel to toes is gradually massaged from 5 minutes. Patients are told to gently massage the skin for the 1st minute, the 2nd minute they can massage a little deeper into the soft tissues, and the 3rd to 5th minutes the massage should get deep into the deeper tissues (fascia, muscle, and tendon). This treatment should be done three times daily. The bottom of the heel gets its own 5 minutes if a bursitis is present. Remember with icing the 4 to 1 rule. If you ice for 5 minutes, the tissue is tight for the next 20 minutes, prone to pull if used, so be careful to go easy on it during the thawing-out phase. This treatment can be used for many months until the final healing of the plantar fasciitis.

1 comment:

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.