Plantar Fasciitis Treatment Part 2:
Current Medical Concepts
Runners experience plantar fasciitis as an overuse syndrome caused by repetitive micro-trauma. The current school of thought is that overload causes micro-tears and degeneration of collagen in the plantar fascia. Many interventions for plantar fasciitis are only temporary.
Some of the treatments for plantar fasciitis used by the medical community include corticosteroid injections, iontophoresis, extracorporeal shock-wave therapy, and surgery.
Corticosteroid injections are an effective treatment in the relief of pain and debility. Response rates are consistently greater than 70%. Even though injections provide relief, they are not a cure-all. The injections are very painful.1
Iontophoresis is a means to force topical corticosteroid into the soft tissue by use of electrical impulses. Scientific, double-blind studies have shown that a significant decrease in symptoms can be obtained in about two weeks. Treatment involves several visits to a physical therapist.
Extracorporeal shock-wave therapy (ESWT) is a proposed treatment for plantar fasciitis. It was previously used as a treatment for urolithiasis (stones in the urinary tract). Studies have shown that ESWT is suited more for use in athletes than in sedentary persons. More research is needed to be able to use this as an established therapy for plantar fasciitis.
The surgery for release of the plantar fascia, plantar fasciotomy, is not the treatment of choice for runners because of the length of time it takes for recovery. They can return to running in about 9 weeks, but full recovery time usually takes about 18 weeks. It has been proposed that endoscopic plantar fascia release would be a better alternative. The return to activity would be quicker and it’s less painful.1
Interventions for plantar fasciitis provide temporary relief at best. One reason for short-term success and long-term failure is that the treatments are calm the condition, but unless underlying factors such as tight plantar fascia, calf muscle tightness, and excessive pronation are addressed, recurrence is almost inevitable.
1. Glazer, James. Physician and Sportsmedicine Magazine; “Plantar Fasciitis” Nov 2004 Vol 32, Issue 11