Plantar Fasciitis: What is it and how do I treat it?
Updated: Sep 14, 2022
Plantar Fasciitis is estimated to lead to over 1 million doctor's visits per year. It is painful and can be debilitating if not addressed quickly, and sometimes even then it persists.
If you have ever struggled with plantar fasciitis, you probably battled it for months and it for some it persists for years.
What is it?
It is inflammation of a thick fibrous band that inserts at the base of heel (calcaneus) and extends outward toward the toes. Symptoms are often worse upon first getting out of bed as you stretch the inflamed fascia and loosen it up. Once you
take a minute to stretch it, then it is
only a dull roar for most of the day and depending on a person's level of activity, it typically increases as the day goes on with prolonged weight bearing.
The causes are not completely understood. Most people are between 40 and 60 years of age when the get it. It is mostly unilateral or one-sided but can be bilateral. It is seen more frequently in runners, thought to be precipitated by repetitive and prolonged microtrauma to the fascia. This can be exacerbated by inappropriate footwear not sized appropriately for the shape of the foot, worn out footwear, or even the shape of the foot. Flat feet have been shown to also be a contributing factor, and as we age, our feet naturally become flatter over times, which likely explains the increase between age 40 and 60 mentioned previously. One thing that is certain is that the symptoms can persist for months. To diagnose plantar fasciitis, there is not labwork or imaging that will make the diagnosis, although imaging can be consider to rule out other diagnosis, such as nerve entrapment, stress fracture of the calcaneus, and multiple other causes. Heel spurs are frequently seen on xrays but studies have shown that heel spurs have no significant correlation to plantar fasciitis, as many patients will have heels spurs and no history of pain. Most of the time and due to the frequency of plantar fasciitis, a physician can diagnose it based on an exam by palpating the foot and eliciting symptoms.
What to do?
Typically, the first line of defense is:
●Performing of stretching exercises for the plantar fascia and calf muscles, which the patient can do at home.
●Avoiding the use of flat shoes and barefoot walking.
●Using prefabricated, over-the-counter, silicone heel shoe inserts (arch supports and/or heel cups).
●Decreasing physical activities that are suggested by the medical history to be causative or aggravating (eg, excessive running, dancing, or jumping).
●Prescribing or recommending a short-term trial (two to three weeks) of nonsteroidal anti-inflammatory drugs (NSAIDs). Use of NSAIDs is reasonable, but their long-term use should be reserved for patients with known systemic rheumatic disease. If you have blood pressure, kidney, or stomach issues, then NSAIDs may not be the best option for those patients.
●Injecting the tender areas of the plantar region with glucocorticoids and a local anesthetic. Glucocorticoids (steroids, cortisone) have drawbacks in that they can cause fat atrophy in the area of the injection, with increasing risk with each injection.
Even when doing everything right, patients will have to continue these conservative therapies for 6-12 months for resolution. 80% of patients will get better by 1 year. For those that don't the last resort is surgery.
Is PRP an option to get better quicker and stay better?
A few recent meta analysis comparisons of various randomized trials were done, one in 2018 and another in 2020, comparing PRP to cortisone or other treatments that showed PRP led to quicker improvement and longer lasting improvement when compared to cortisone, and without any of the risks inherent with cortisone injections. Another Systematic review of PRP studies for plantar fasciitis showed that PRP was much more effective with better pain relief and better function outcomes at 6 month, 1 year, and 1.5 year follow up.
I have been treating plantar fasciitis patients in my clinic for several years. I use ultrasound guided injections and I have been seeing results in patients that have struggled with plantar fasciitis who have failed all other treatments. PRP has helped those chronic patients as well as those with more recent symptoms, that want to speed up the healing process from the typical 6-12 months it takes using conservative approaches.
PRP makes sense. You are concentrating your bodies growth factors and cells that normally promote healing and you are amplifying the effect in an area that those cells and growth factors cannot normally get to, which is why those areas including the plantar fascia have difficulty healing. The other significant benefit, is that PRP is safe. There is no inherent risk from the PRP itself, since it is not a foreign or exogenous substance being put into the body. It either works, which the odds are in your favor, or it doesn't, but at least the PRP didn't make it worse.
I always advise my patients that they need to work with the PRP, not against it. They should avoid limiting things they know will aggravate it, such as going back to running before they are healed up, or continuing to go barefoot or using footwear that is not suited for their foot. PRP can speed up the healing, but they still must be patient. Instead of the 6-12 months, a lot of patients can get healed by 4-8 weeks. In rare cases, a second PRP injection at 8-12 weeks can be offered to maximize benefit if patients still haven't gotten to the level of healing they expected.
You can find more information regarding PRP for plantar fasciitis and its use for other orthopedic conditions at www.bluefireprp.com.
We also recommend a supplement from www.bluefiresupplements.com called JointLife to help the symptoms associated with plantar fasciitis while awaiting the PRP to take full effect as an alternative to NSAIDS.