It’s not plantar fasciitis!
No matter what they say, and what you think, it’s not plantar fasciitis that you are suffering from, and we (read I) want to change the way everybody who comes to my office looking for help thinks about this condition. Most of the time I will help you get better, no matter what your thoughts are, but if I can convince you to think about this differently, I can get you better faster. Period.
I’m revisiting this subject because so many patients are complaining of foot pain. And with the Sun Run clinics popping up everywhere, and more people training for this popular race than ever, this is even more important to address. You can read previous articles, but today there is no beating around the bush. I’m going to tell you my thoughts on this most prevalent condition.
First for the quick update as to what this condition is. Plantar fasciitis (which should be renamed plantar fasciosis – I’ll explain) is a painful inflammatory process of the plantar fascia. Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis. (Wikipedia)
“It is entirely possible that our whole paradigm for treating plantar fasciitis is based on a false foundation, especially in light of the histological findings of Lemont, et. al., regarding specimens of resected plantar fascia.3 Clearly, these authors’ objective histological evidence must make all those who treat plantar fasciitis rethink their concept of the true etiology of plantar fasciitis. Their proposal that the condition we so commonly refer to as plantar fasciitis be called “plantar fasciosis” is valid and more accurately describes the condition. These findings are further supported by histological analysis of surgical biopsies of tendons which were affected by “tendonitis,” but had no markers of inflammation.4,5 ”
What researchers have found is that the “fascia” actually thickens, possibly due to mechanical stresses and/or repeated trauma. Therefore it is thought that this thickening causes less blood flow through the area, thus healing is slowed or arrested as small blood vessels are “squeezed out”. Using the latest in thermography imaging, I have found that in my practice, typically no inflammation becomes apparent.
So how do I treat plantar fasciosis? Neuromuscular therapy (NMT) is the stating point. Posture and gait are of the upmost importance. Can’t fix something when your centre of gravity is off. Then, physical massage of the area, stretching and releasing any adhesions that may be felt. This might parallel Shock wave therapy, a method used to break adhesions and promote healing. Next, the use of Low Intensity Laser Therapy. It is thought that using LILT promotes the formation of new blood vessels (angiogenisis). In one study cited in the Photomedicine and Laser Surgery Journal, “Red LLLT (Low Level Laser Therapy) and LED demonstrated expressive results in angiogenesis.” And more blood flow to an area, the better the healing.
Following 1/2 hour of Laser, Kenesio taping of the foot. Kinesio Taping alleviates pain and facilitates lymphatic drainage by microscopically lifting the skin. The taped portion forms convolutions in the skin, thus increasing interstitial space. The result is that pressure and irritation are taken off the neural and sensory receptors, alleviating pain. Kinesio Taping can be used in conjunction with other therapies, including cryotherapy, hydrotherapy, massage therapy, LLLT and electrical stimulation. I personally believe this tape gives the support needed but also allows freedom of the natural movements of the foot.
I also find, contrary to beliefs on this condition, that heat applied to the plantar surface is more benifical that ice. It stands to reason that if there is no inflammation present, then icing will slow the metabolic processes in the area. I believe that after the above treatments, warming thickened tissue and increasing the metabolic activities is what is called for.
Depending on how chronic the condition is, treatment 2-3 times a week for a couple of weeks should get the healing well on it’s way. From there, it’s a matter of staying on top of things as necessary.
This condition is a tricky one and it can sneak up without warning. The first step is to see someone about it sooner rather than later. Our results have been quit impressive with treating this condition. However an clinical study is about to begin within our office. If you would like to be part of our study, please do not hesitate to contact me.
Peter Roach, RMT, CNMT, Laser Therapist