Treatment options for plantar fasciitis

PF is considered a self-limited condition - since >80% of cases resolve / heal within 12 months regardless of therapy

“An ounce of prevention . . .”

Best treatment is prevention.    This involves being sensitive to early warning signs and using preventative exercises; after a hiatus, runners should warm up gradually to a full workout program

Prefer conservative therapies to surgery

General recommendations

Cease activities known to induce trauma / inflammatory stress on plantar fascia.    Athletes will need to be patient to allow time to heal

Speedy treatment prevents further problems developing as a result of an altered gait in response to foot pain.   Such problems may affect the knee, hip and/or spine and will need to be addressed to facilitate complete healing.

Plantar Fascia strengthening / Stretching Exercises.   With the overall goal of stretching the tightened plantar fascia along the foot arch. There is a growing study/experience-supported opinion that a program of non-weight-bearing stretching exercises specific to the plantar fascia is superior to the standard program of weight-bearing Achilles tendon-stretching exercises

Exercises to stretch tightened plantar fascia

Other stretching / strengthening exercises may be necessary to strengthen weak muscles affecting the problem.     E.g. strengthening calf muscles

Prevent sheets at the foot of the bed from putting too much pressure on the feet

Wear good arch-supportive footwear and a well-cushioned heel

Night splinting to hold ankle joint in a neutral position.    Prevents foot from becoming flexed in the night

Nutritional therapy

-    Connective tissue repair/ regeneration

•   Vitamin C

• Antioxidant property fights inflammation

• Increase PF tensile strength - essential for building procollagen (collagen precursor).

Recommended Dose: 1 - 3 g ascorbic acid /day

•    Zinc.   Generally recognized for its positive effect on the immune system

• Works with C to increase PF tensile strength.    Zinc insufficiency (common in high stress people or those with injuries) implicated in delayed wound healing

Recommended Dose: 15-30 mg zinc / day

•   Glucosamine - foundational substrate for several compounds associated with repair and regeneration of connective tissue, including hyaluronic acid and other glycosaminoglycans (GAGs)

Recommended Dose: 500mg glucosamine sulfate 3 x /day

-   Anti-inflammatories

•   Vitamin C

•   Bromelain - family of proteolytic enzymescommonly used for treating soft tissue injuries and treating inflammation

• Reduces swelling / pain;

• Increases fibrinolysis (promotesplasminogen à plasmin)

Taussig SJ, Batkin S. Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application. An update. J Ethnopharmacol 1988;22:191-203.

Recommended Dose: 500 -2000 mg/day (with enzymatic activity of at least 2,000 mcu/g)

•   Omega-3 EPA and DHA.    Notable anti-inflammatory fatty acids

Recommended Dose: 1000mg Neptune Krill Oil / day or 4 - 1000 mg capsule Wild Salmon Oil or eat oily fish 2-3 times / week

Also see general recommendations to counter and control inflammation found at:

Inflammation - Can't live with it, Can't live without it!

NIR Class 4 laser therapy

NIR class 4 laser therapy restores the flow of nutrients and oxygen to inflamed tissue and increases cellular waste removal, thus allowing the cells to repair themselves more quickly than when left untreated

NIR Class 4 Laser Therapy

One particular study is sometimes referenced to denounce the efficacy of laser treatment for plantar fasciitis.    However, it is noted that this study used a very low power (30mW) laser, which would not penetrate tissue like the higher-powered lasers used in NIR class 4 laser therapy

Basford JR, Malanga GA, Krause DA, Harmsen WS. A randomized controlled evaluation of low-intensity laser therapy: plantar fasciitis. Arch Phys Med Rehabil.1998 Mar;79(3):249-54. PubMed

Other healing alternatives to surgery include

 (without reference to their efficacy):

•  Injections / Medication.    For temporary relief  E.g. anti-inflammatories such as steroidal corticosteroid injections and NSAIDS E.g. celecoxib, ibuprofen, naproxen

•  Extra-corporeal shock wave therapy (ESWT).    Pulses of high-pressure sound waves

•  Orthotics / Heel cups / Arch support

•  Magnetic insoles

•  Ultrasound

•  Strapping/Taping

•  Therapeutic ultrasound

•  Chiropractic (manipulative therapy)

•  Soft tissue therapy / massage

•  Heat

•  Ice.    Anti-inflammatory effect

•  Acupuncture

Stuber et al reviewed the efficacy of randomized, controlled, clinical trials (published in English between1980 and 2005) involving different conservative modalities to treat plantar fasciitis.

Kent Stuber, BSc, DC^,Kevyn Kristmanson, BSc, DC.Conservative therapy fpr plantar fasciitis: a narrative review of randomized controlled trials J. Can Chiropr Assoc.2006 June;50(2): 118-133. PubMed