Treatment For Plantar Fasciitis

In today’s information age, one can Google treatment of plantar fasciitis and see a myriad of different types of treatment, all of which work but not necessarily work for everyone. Treatment sometimes needs to be tailored to that specific individual’s condition taking into account: 1) length of time of symptoms, 2) previous treatments rendered for condition 3) patient’s lifestyle, among other considerations.

1. The key to relieving plantar fasciitis in the long term is to stop the repeated over-stretching of the fascia in gait. We employ a state-of-the-art computerized gait analysis which analyzes the feet in both a static and dynamic position and based on the data collected, one can determine the mechanical imbalances and abnormal stresses that are being placed on the feet. This data is then utilized to manufacture a customized prescription foot orthotic which will stabilize the foot in a position that relieves the stress on the plantar fascia and remaining parts of the foot. Many patients have the impression that they will receive the prescription orthotic and that is it. That is actually the start of treatment as the patient becomes accustomed to the beneficial changes in gait and the plantar fasciitis gradually fades into oblivion.
   
2. There are a number of other treatments for plantar fasciitis, like cortisone shots, but they are for temporary relief only and can have side effects if used incorrectly. A prescription for physical therapy or massage therapy can also provide temporary relief in a safer fashion. Other forms of treatment include, but are not limited to, stretching of the calf muscles, night splints, ice massage. A patient’s lifestyle is a big factor on the success or failure of any specific treatment. This needs to be taken into account when treating this condition and temporary changes in a patient’s activity can be instrumental in the success or failure of their treatment.
   
3. How long have symptoms been present? The longer one has been suffering with these symptoms the more likely the fascia will degenerate due to chronic inflammation of the fascia. Our bodies handle chronic inflammation very poorly, so if the fascia has been inflamed for a very long time, it may not heal no matter what we try on a conservative nature. Usually, when we treat the inflammation and correct the biomechanics of the feet the condition usually takes care of itself in most instances. If that doesn’t happen, the common treatment used to be surgery whereby the fascia is cut off the heel bone.
   Now with modern up-to-date technologies, such surgery has been replaced with Extracorporeal Shockwave Therapy (ESWT) in which repeated shockwaves are applied to the fascia(It is also effective for achilles tendon problems), or via Coblation Therapy via the TOPAZ procedure. This procedure is a minimally invasive procedure for plantar fasciitis that involves use of a small wand made by Arthrocare. It employs radiofrequency utilized by the surgeon to debride or thin the fascia at the heel, that is, remove the diseased tissue causing the heel pain. The procedure is performed via tiny “puncture” holes made in the skin at the bottom of the heel that require no sutures and leave no scarring. Patients can walk on the area the next day.Learn More at www.TopazProcedure.com.
   Both treatments convert the chronic inflammation to acute inflammation which the body handles very well in repairing the fascia by bringing new blood vessels (neovascularization) to the region. ESWT can be accomplished via one or two high energy session involving anesthesia or by low energy ESWT in which 3 low energy sessions are used in place of one high energy session and no anesthesia is usually needed. ESWT is successful 70 to 80 percent of the time when the plantar fascia does not respond to conventional treatments. One financial issue to consider is that ESWT has very limited coverage by health insurance companies, so it is generally an out-of-pocket expense. Coblation therapy is generally a covered service.
   
4. Other more advanced treatments of plantar fasciitis include:
   
   • MLS Laser Therapy: MLS laser is a modality supplied by Cutting Edge Lasers (www.med.celasers.com). The laser works by employing two synchronized wavelengths of light which treat damaged tissue at the cellular level to stimulate healing, reduce inflammation and pain. CE Lasers were initially sold to the veterinary market in the US despite fairly widespread use of the products in Europe. There is no placebo effect with animals.
   • Platelet Rich Plasma (PRP): Platelet rich plasma has become a popular and somewhat glamorous new treatment modality used by professional athletes for injuries. PRP is a concentrate of whole blood of the patient in which the platelets are concentrated in a small portion. The platelet concentrate is then re-injected into the injured area. Platelets are involved in the clotting mechanism so bruising and swelling can be decreased. Platelets contain growth factors so, in concentrated form, the amount of growth factors can be increased in an injured area. Results in the press and literature have been mixed, but there is a reason for this in my opinion. PRP is often used as a primary treatment or sole treatment. There may be a benefit to do so but the underlying cause of tendon and ligament pathologies must first be addressed otherwise lasting relief may not occur.
   • Topaz Coblation and Extracorporeal Shockwave Therapy(ESWT): Previously described above.

…Coming up next – “Orthotics are NOT all created equal”