Plantar fasciitis is one of the most common causes of heel pain in North America. It’s estimated to affect 10% of the population and the diagnosis and treatment of heel pain accounts for over 1 million visits per year to the physician’s office. It’s more common in adults over 50 and despite the fact that this condition is common and often disabling, the optimal diagnosis and treatment is still unclear. The pain can be severe, and often worse first thing in the morning after the plantar fascia tightens up overnight.
Itis vs. Osis – What’s In A Name?
The plantar fascia is a band of connective tissue at the bottom of the foot that connects the heel bone to the toes. It acts as a shock absorber and also supports the foot arch. The suffix ‘itis’ denotes inflammation; therefore plantar fasciitis suggests inflammation of the plantar fascia.
However, when researchers biopsied samples of the plantar fascia from people who suffer from this condition they found signs of degeneration of the tissue instead of the typical markers of inflammation. The degenerative changes are most likely due to repetitive micro-tears of the fascia that are unable to properly heal.
Based on this research, the term ‘plantar fasciosis’ (“osis” meaning abnormal condition or process) is now the preferred term for many researchers and clinicians.
Plantar faciitis is still the more commonly used term and as such it’s what I will use in this article. However, aside from the confusion around the name, the real issue with this discrepancy is that most of the treatment approaches focus on reducing inflammation. While this may benefit certain cases where inflammation is indeed present, it’s misleading and often not the proper approach.
Causes of Plantar Fasciitis
There are a number of potential causes and risk factors for developing plantar fasciitis. It occurs in both men and women, active and sedentary, with runners being the most affected. It can be the result of an acute injury, but most often it comes on insidiously. Individuals with low arches (flat feet) or high arches are both at an increased risk of developing plantar fasciitis.
Modern footwear is thought to be one of the contributors to developing plantar fasciitis. Most shoes cause the big toe to be pushed inwards and extended upwards, which can compress the blood supply to the plantar fascia and greatly increase tension on the flexor muscles on the bottom of the foot. This is aggravated by standing or running on hard surfaces, and it has been shown that cultures that spend the majority of their time barefoot rarely suffer from plantar fasciitis and other running related injuries.
8 Naturopathic Remedies for Plantar Fasciitis
As the underlying cause is still poorly understood, treatment options for plantar fasciitis are widely variable and often ineffective. Most cases are self-limiting and will resolve on their own, but it can take 6-18 months to heal. Proper footwear, limiting aggravating activities (i.e. running), and stretching/strengthening exercises can help speed up the healing process. However, many people will suffer with chronic pain and seek additional treatment options. Many of these people end up in my clinic, where we employ a variety of treatment techniques, which are outlined below.
1. Orthotics For Plantar Fasciitis
Proper footwear and both generic and custom orthotics are often recommended for plantar fasciitis. A study found that non-supportive orthotics do not reduce pain, whereas supportive foam orthotics do provide short-term pain relief. Other review studies have shown that both generic and custom orthotics can be effective at reducing plantar fasciitis pain.
Custom orthotics appear to offer similar pain relief as corticosteroid injections, without the potential side effects such as injection site pain. While proper footwear and orthotics can provide relief for some people, others may continue to suffer from chronic pain. In these cases, additional treatment options should be considered.
2. Acupuncture for Plantar Fasciitis
It’s well documented that acupuncture can be an effective tool for pain relief, and the same holds true for heel pain due to plantar fasciitis. It’s interesting to note that although acupuncture often involves directly needling the injured or painful area (i.e. the heel), there are also ‘distal’ acupuncture points that are indicated for specific areas of the body or conditions.
An example of this is a randomized trial that compared the effect of needling the acupuncture point PC-7 (which is located on the wrist, but indicated for heel pain) with needling LI-4 (also located in the hand, but not specific for heel pain). The treatment group, which received needling at the acupuncture point PC-7, experienced significantly greater pain relief compared to the control group that received needling at acupuncture point LI-4.
3. Electro-Acupuncture for Plantar Fasciitis
Electro-acupuncture is another treatment that has shown to be effective for plantar fasciitis. This therapy is similar to acupuncture, however a micro-current is applied to the acupuncture needles to electrically stimulate the points.
In a randomized controlled trial comparing conventional treatment with electro-acupuncture to conventional treatment alone, researchers found that “electro-acupuncture coupled with conventional treatments provided a success rate of 80% in chronic plantar fasciitis [and] was more effective than conventional treatments alone. The effects lasted for at least six weeks.”
4. Dry Needling for for Plantar Fasciitis
Heel pain can also be associated with myofascial trigger points — knots in the muscle that cause both local and referred pain as well as motor dysfunction. The most common trigger points associated with plantar fasciitis are in muscles of the calf and dry needling of these myofascial trigger points has been shown to significantly reduce heel pain.
5. Cupping for Plantar Fasciitis
Cupping is another form of treatment in Traditional Chinese Medicine that involves placing glass or plastic suction cups on muscles to improve blood flow and reduce pain. Cupping was popularized by swimmer Michael Phelps after he appeared at the Olympics with round ‘bruise’ marks over his skin.
Cupping has also been studied for plantar fasciitis, in which one group received cupping therapy twice a week for four weeks, while the other group underwent electrical stimulation therapy. The results indicated that both cupping and electrical stimulation therapy significantly reduced pain and improved foot function
6. Low-Level Laser Therapy for Plantar Fasciitis
Low-level laser therapy, also called ‘cold laser’ or ‘low intensity laser’ therapy is an effective, non-invasive treatment for both acute and chronic pain and injuries. It uses specific frequencies of light that penetrate to the cellular level and stimulate the production of ATP (the energy used by cells) to facilitate tissue healing.
In a prospective study, participants with plantar fasciitis were treated with low-level laser therapy twice a week for 3 weeks. At the follow up 12 months after the treatment, pain scores had improved significantly from 67.8 out of 100 at baseline to 6.9 out of 100. Foot function scores also improved significantly following treatment and at 12 months follow up. The researchers then repeated the study in a randomized controlled trial (considered the gold standard for research), and found that individuals treated with low-level laser therapy experienced significant improvements in pain scores compared to placebo. Although additional studies are warranted to further demonstrate it’s effectiveness, low-level laser therapy is a promising treatment for plantar fasciitis that’s not only safe but also painless and non-invasive.
7. Prolotherapy for Plantar Fasciitis
Prolotherapy (“proliferative therapy”) is a technique that uses injections of a dextrose (sugar) solution into the attachment points of tendons and ligaments to facilitate healing of these tissues. It’s used for pain, injuries and degeneration of any joints in the body, and has been shown to be an effective treatment for plantar fasciitis.
In an observational study on prolotherapy for unresolved foot and toe pain, 19 patients who received prolotherapy for their foot pain were asked to rate their experience. These patients had seen several doctors and had suffered with foot pain for an average of 4.5 years.
The average pain rating before treatment was 7.1/10, and this was reduced to 2.3/10 after treatment. When asked, “has Prolotherapy changed your life for the better?” 100% of the participants treated answered “Yes.”
A separate study on the use of dextrose prolotherapy for chronic plantar fasciitis was published in the British Journal of Sports Medicine. Twenty people who didn’t see improvement in their plantar fasciitis symptoms following conventional treatment were referred for three prolotherapy sessions. After treatment they reported significant improvements in pain levels at rest, activities of daily living, and during or after physical activity, with 80% of the participants reporting a “good to excellent” outcome.
8. Platelet-Rich Plasma (PRP) Injections for Plantar Fasciitis
Another technique that has shown success in treating chronic plantar fasciitis is platelet-rich plasma (PRP) injections. PRP involves drawing a patient’s blood, removing the portion that’s rich in platelets (similar to stem cells), and re-injecting the solution into the damaged joints. In a study comparing PRP injections to Prolotherapy for chronic plantar fasciitis, researchers found that both techniques improved pain and disability. The PRP seemed to demonstrate a greater benefit initially, but both groups showed significant improvements at the last re-evaluation.
PRP has also been compared to the cortisone injections (a standard conventional treatment). Cortisone injections help with short-term pain relief, but don’t have lasting results, and have the potential for negative side effects such as tissue deterioration. The authors of this study concluded that, “PRP was more effective and durable than cortisone injection for the treatment of chronic recalcitrant cases of plantar fasciitis.”
