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For mild cases of plantar fasciitis, conservative management is usually effective in controlling the inflammatory process and reversing the damage (without needing any further treatments). In fact, conservative management is often effective in more than 80% of cases of plantar fasciitis, often resolving the pain within a few months.
Early initiation of conservative remedies is the key to managing your pain and inflammation while minimizing the risk of disability and chronic inflammation. The longer you experience plantar fasciitis pain or delay seeking treatment, the less likely you will improve from conservative treatment. The initial treatments for plantar fasciitis involve a combination of specific treatments with the goals being to: control the inflammatory response; limit further injury; and, promote healing.
Ice or cold compresses alleviate the symptoms of pain and discomfort. You can massage the bottom of your foot with an ice pack wrapped in a towel. Rub an ice-pack gently over the tender area on your heel for 15 to 20 minutes, 3-4 times a day.
Additionally, rolling your foot on a bottle of frozen water can also give quick relief from pain and discomfort. Ice massage can also be used as a preventative measure to minimize the attacks of pain after long periods of rest or inactivity.
Therapeutic deep tissue massage to the heel pad and back of the calf muscles is known to help the pain, swelling and discomfort associated with plantar fasciitis. When performed in expert hands, deep tissue massage helps release tension and break scar tissue. If the massage is aggressive, you may experience some pain or soreness after the massage, which resolves in a few hours or occasionally, a few days.
Improper footwear is a leading cause of plantar fasciitis and other foot disorders (such as Morton’s neuroma). Some footwear recommendations for patients with plantar fasciitis include:
Custom made shoes are another suitable option in special cases (such as congenital or acquired foot deformities and postural disorders of foot/ leg). Remember: wear shoes that work with your feet not against them!
Night splints help in stretching your calf muscle and supporting the arch of your foot. The night splint assists in holding the plantar fascia and the Achilles tendon in an elongated position during sleeping to expand the fascial sheath. Night splints need to be used each night regularly and failure to wear these nightly limit their effectiveness. Poor sleepers have particular difficulty with this treatment as the splints disrupt their sleep. Various studies suggested that regular use of tension night splints with stretching, heel cups, NSAIDs and shoe modification can resolve Plantar Fasciitis symptoms completely (without needing any other therapy).
A simple way to treat the pain of plantar fasciitis is through the use of medications which are used in conjunction with other interventions such as stretching. They can help to reduce pain enough to facilitate stretching, physical therapy and exercise. However medications have a minimal role in treatment or prevention of plantar fasciitis and should be reserved for temporary use only.
NSAIDs have minimal role in treatment or prevention of plantar fasciitis and should be reserved for temporary use only.
We use a type of ESWT called Extracorporeal Pulse Activation Technology or EPAT® which has been shown to be very effective when used in early plantar fasciitis. Extracorporeal Pulse Activation Technology uses high frequency sound waves that are directed at the most tender part of the heel to promote healing.
EPAT offers fast recovery allowing you to resume your daily living activities quickly. It is estimated that extracorporeal shock wave therapy is effective in resolving greater than 70% of cases of persistent plantar fasciitis pain. Recent studies have shown that patients with heel spurs, edema or high pain scores respond better to EPAT. The exact therapeutic mechanism of shock wave therapy still remains a topic of speculation despite extensive research. It is thought that sound waves damage tissues to induce microtrauma, which stimulates the healing process by attracting blood vessels and nutrients to the plantar fascia. The sound waves also inhibit pain receptors.
The Procedure. Our protocol for EPAT is a course of 3 treatments, each 2 weeks apart. The procedure is generally well tolerated with minimal discomfort.
Side effects are rare especially when procedure is performed in expert hands. Side effects may include: bruising, post-procedure inflammation, discomfort, pain, swelling and tenderness (all of which usually resolve spontaneously.) Contraindications to EPAT include: a history of hemophilia or other coagulopathies; malignancy; and open bone growth plates (physes.)
Relief: Many patients have pain relief immediately after EPAT. EPAT has a cumulative effect so repeating the procedure can be beneficial. The full effect each course of treatment may take up to 6 weeks.
If conservative measures do not result in adequate pain relief then an ultrasound guided corticosteroid injection is a possible alternative.
Ultrasound guided steroid injections are widely used in the management of plantar fasciitis however their use has recently declined due to the risk of fat pad atrophy. Use of ultrasound guidance helps in increasing the accuracy while reducing the risk of side effects including fat pad atrophy. One well placed steroid injection can resolve pain for a period of up to 4 weeks and minimize the risk of inflammatory swelling for up to 3 months. Studies have shown that a corticosteroid injection is more likely to be successful if the ultrasound shows peri-fascial edema.
Side effects of this procedure are; transient numbness, pin and needle sensations and localized discomfort. Repeat corticosteriod injections should be done with extreme caution since long-term steroid therapy may aggravate the risk of damage such as tearing of the plantar fascia, atrophy of the skin, heel muscles and fat pad, degeneration of tendons etc. and is therefore not recommended.
Other conservative remedies should be used in conjunction with ultrasound guided corticosteroid injections such as orthotics and stretching exercises. However, if your symptoms are not resolving or getting worse over time, you should consider other nonsurgical procedures for the treatment of persistent plantar fasciitis.
Physical therapy exercises performed under the supervision of a physical therapist help in strengthening and stabilizing the plantar fascia, Achilles tendon and Gastrocnemius muscles, which in turn, improves the integrity of the plantar fascia and other connective tissue components of lower leg and minimize the risk of injuries.