As I research around the web including social networks websites, online forums and post there is an abundance of info about plantar fasciitis. Unfortunately much of it’s outdated and just thrown up principles, theory’s and treatment choices that simply have been proven wrong or don’t work.
As a hand and foot chiropractic practitioner in Melbourne, FL I have actually spent the past 15 years studying foot conditions, especially plantar fasciitis. What was taught as factual in school has actually now been proven to be obsoleted and ill sensible. What I am going to reveal are not simply my views but, are all backed by scientific literature. I am continuously developing in my quest of offering the best possible treatment alternatives for my clients and for that reason research is essential. The understanding I have acquired from this research study has actually changed the treatment I now utilize today to treat a patient with plantar fasciitis treatment compared to exactly what I used early on in my practice.
So exactly what are these out-of-date concepts, theories and treatment options I continue to check out. Lets start with the name itself. Plantar Fasciitis. In medical terms this informs us that the plantar fascia (really it’s called the plantar aponeurosis) of the foot is inflamed. It prevails knowledge on the internet that the plantar fascia is inflamed typically at the insertion on the heel. The current’s research suggest that swelling has little to do with plantar fasciitis. At first there might be some swelling although the condition becomes more of a degenerative disorder instead of an inflammatory condition. So what does it matter whether it is inflammatory versus degenerative? It is necessary because it alters the kind treatment that ought to be administered. An example. If a patient has inflammation they would be treated with over-the-counter anti-inflammatory medication (NSAIDS) such as Advil, prescriptive anti-inflammatory or with an anti-inflammatory injection such as a steroid. These may work treatment options for lowering swelling nevertheless, they won’t help much if there is little or no inflammation present such as in degenerative conditions.
So what does the scientific literature need to state? A 2003 review of 50 cases carried out by Lemont et al specified that plantar fasciitis is a “degenerative fasciosis without inflammation, not a fasciitis.” 1. In medical terms a suffix of -itis implies inflammation where -osis suggests degenerative. Andres et al. wrote in the journal Scientific Orthopedics & Related Research study “Current standard science research study recommends little or no inflammation exists in these conditions”. 2. A post titled Overuse tendinosis, not tendinitis, part1: a brand-new paradigm for a difficult medical problem released in Phys Sportsmed states “many investigators worldwide have shown that the pathology underlying these conditions is tendonosis or collagen degeneration”. 3. I can go on pointing out a lot more although you can see that the experts agree that the theory of swelling present in plantar fasciitis not legitimate.
Another common mis-conception is that Plantar Fasciitis is brought on by bone spurs. When a patient provides to my workplace with Plantar Fasciitis and a heel spur is noted on an x-ray I say something which may sound very odd to the patient “A heel spur is your friend”. I constantly get the look of “Did you just say what I believe you said?” I then continue with “Let me describe … “. I then continue, “Plantar fasciitis is caused by persistent inflammation of the plantar fascia, typically at the insertion on the heel where the bone exists. With time the plantar fascia begins tearing far from the bone. The body reacts by calcifying (hardening) the tendon and keeping it intact avoiding it from tearing off the bone!”. Thus, why it is refrenced as a “friend”.
Despite the fact that spurs prevail with plantar fasciitis the spur itself does not cause discomfort but, the fascia or surrounding soft tissues really trigger the discomfort. 4. Surgery usually is not successful for easing the discomfort and the stimulates frequently return given that the root of the problem has actually not been removed. 5
What about flat feet (pronation-often discovered with flat feet) or tight calves. I believe these do location increased stress on the plantar fascia and contribute to plantar fascitis although I do not think they are a root issue of plantar fasciitis. There are many people with dropped arches, pronation and tight calves that do not have plantar fasciitis. There are likewise lots of people with plantar fascitis that do not have flat feet, pronation or tight calves. Early on in my profession I treated clients with plantar fasciitis who were flat footed by fitting them with a custom orthotic to bring back the arch. Although this did help reduce the discomfort really typically it did not eliminate it. If flat feet was the cause then the client ought to have been treated. It’s been my own medical experience that has show me that high arches and supination are just as bothersome as being flat footed or having a foot with pronation.
So as a hand and foot chiropractic specialist exactly what do I think is the origin of plantar fasciitis? In most cases I think it is a foot that is not appropriately functioning. This may be from a bone out of place such as the Talus or Calcaneous (which I see all frequently) a distressing injury or a genetic defect. The human foot has 26 bones, 33 joints, 107 ligaments, 19 muscles and tendons and is extremely complicated. When all these parts are not working appropriately in sync it places unnecessary tension on the foot and triggers degeneration to take place.
Lemont et al. Plantar fascitis: a degenerative procedure (fasciosis) without swelling Journal of the American Podiatric Medical Association. 2003.
Andres et al. Treatment of tendinopathy: what works, exactly what does not, and exactly what is on the horizon. Medical Orthopaedics & Related Research Study. 2008.
Khan et al. Excessive use Tendinosis, not tendinitis, part 1: a new paradigm for a difficult medical proble.m Sportsmed. 2000.
Tountas et al. Personnel Treatment of subcalcaneal discomfort. Clinical Orthopaedics & Related Research Study. 1996.
Fishco et al. The instep plantar fasciotomy for persistent plantar fasciitis. A retrospective evaluation. Journal of the American Podiatric Medical Association. 2000. https://mybowentherapy.com/plantar-fasciitis-treatment-massage/