Plantar fasciitis can be a painful, debilitating injury to deal with. Treatment can vary widely, depending on individual needs and environmental factors. While there is no single treatment for plantar fasciitis that works perfectly for every case, treatment is often progressive in nature.
Conservative methods of treating plantar fasciitis include activist modification, tissue-specific home exercises, footwear changes and custom orthotics. Usually treatments involve multiple methods and for many people this effectively resolves the injury.
But, what happens when you’re not one of those people? What do you do when conservative methods of treatment aren’t enough? Good news! There are more options to treat chronic or stubborn plantar fasciitis symptoms.
Night Splints are one of the options when dealing with stubborn morning pain. If you are continuing to experience pain despite having modified your activity, changed your shoes and been regularly wearing your orthotics, night splints could be the answer. This option can be particularly effective when also dealing with a tight Achilles tendon, which often affects the healing of plantar fasciitis.
Night splints work to keep the foot at a 90 degree angle while sleeping. When the foot is allowed to be lax during sleep, the plantar fascia is allowed to rest and heal in a slightly shortened position, making those first few steps in the morning extra painful as the tissue stretches. By maintaining a light stretch through the plantar fascia during sleep, the tissue rests and heals in a longer position, often easing the pain of those first morning steps. There are several configurations of splints available, both ready-made and custom-made. Depending on your individual needs, your Pedorthist may recommend a splint with certain characteristics.
The Strassberg sock isn’t just any old sock. It’s another tool that can be used to ease the pain of plantar fasciitis in the morning. The Strassberg sock is a device that maintains tension on the plantar fascia through the night and works in a similar manner to many night splints. The sock works via a strap that attaches around the calf and onto the toe of the sock to maintain the foot position. Less aggressive than some of the splints, the sock allows a small amount of motion through the foot and ankle, but allows less motion through the toes.
Some patients find the Strasberg sock more comfortable and less disruptive to sleep, while others prefer a more rigid splint. Both solutions aim to achieve the same effect, and tend to have a positive effect on healing rates and pain reduction. Depending on your individual needs and other existing medical conditions, your Pedorthist can advise you if the Strassberg sock is right for you.
Many people have seen great results with using one of these devices as an adjunctive treatment for plantar fasciitis. But, there are a few things to be aware of. Splints can be disruptive to sleep because they restrict natural movement and can be on the bulky side. Those who have a history of swelling, numbness or other neurovascular problems in the feet or lower legs should consult their physician before trying a splint or Strassberg sock, as restricting movement may not be suitable.
Shockwave Therapy is another treatment that can be used to treat plantar fasciitis. This therapy uses high pulses of energy directly on the plantar fascia area to relieve pain. Originally developed as a means to break down kidney stones, this therapy is now used in other areas of the body to relieve pain by “breaking down” scar tissue and alleviating tension. There have been positive results when using the therapy to treat plantar fasciitis, Achilles tendinitis, and even shoulder and rotator cuff tendinitis.
Shockwave therapy is safe, but may cause some discomfort during or after treatment. One of the problems with shockwave therapy is that is can take months to begin to see improvements, as it takes the body that long to begin to repair connective tissue like the plantar fascia. Another barrier for some sufferers is the cost. In Canada, shockwave therapy can cost anywhere from $600-$800 per foot, and up to 33 percent of people may not see satisfactory results from the therapy.
Several studies on shockwave therapy have shown great results in terms of pain relief and symptom resolution. If you are considering this option, discuss this treatment with your family doctor or your Canadian Certified Pedorthist to see if it is right for you.
To learn more, check out SoleScience’s very own Adam Froats explaining shockwave therapy in this video:
Cortisone injections are another common treatment for recalcitrant, stubborn plantar fasciitis. Cortisone is a synthetic hormone, similar to cortisol, which acts as an anti-inflammatory throughout the body. When cortisone is injected into the plantar fascia, it provides local pain relief and reduces inflammation. In those who experience positive results, the results tend to be rapid, but some people don’t experience any positive effects from this treatment.
While the benefits tend to be rapid and effective, there are also some drawbacks. One of the most important risks to consider is cortisone can weaken tissue, increasing your risk for rupturing your plantar fascia. Also, the injection itself can be painful, and may lead to acute inflammation immediately following the treatment. Infection is uncommon, but has been reported in some cases. Patients with diabetes should consult their family physician prior to considering cortisone, as this treatment may affect blood glucose levels.
Step to Conclusions
Plantar fasciitis can be a stubborn, difficult and painful injury to deal with, but SoleScience is always here to help! As you can see, there are several treatment options available to you. For more information on plantar fasciitis, check out our injury locator for tips on how to feel better, and stay tuned for next week’s comprehensive post with more information on plantar fasciitis!