Plantar fasciitis is actually several conditions that affect the heel. The affected areas may include the plantar fascia insertion on the heel bone, the calcaneal bursa, the actual heel bone and the nerves on the medial side of the heel and the plantar heel. Treatment for this condition begins with shoe recommendations, mainly centering on a stiff-soled shoe with good structure and additional recommendations for a pair of orthotics or Custom Medical Grade Footwear. We will also try to have patients maintain use of an arch-supporting shoe, even within the home. We usually begin with physical therapy as a first-line treatment, both at home by the patient and with a physical therapist. We then adjust treatment based on the acute or chronic stage of diagnosis.
If the problem is acute, we often use anti-inflammatory treatments, gentle stretching and support through continued taping. However, a majority of the heel pain we see is more chronic in nature. In these cases, we add Graston scraping of the fascia and deep massage to break up the chronic scar tissue formed in the fascia due to chronic tears and fibrous changes. This process can last about four to six weeks and has a recovery rate of 70%. A single cortisone injection is recommended if the patient is still having issues after this treatment. We locate the inflamed areas and provide the injection as required, and most commonly we find that it is only required in the fascia region. However, if the bursa region is inflamed, we will also deliver an injection to that region. This helps another 10% of patients stop their residual pain.
We treat chronic cases of fasciopathy with what we call adjuvant therapy. This category includes shockwave therapy, platelet-rich plasma (PRP) therapy, amniotic cell injection or any other treatment that will result in inflammation and a response from the body to heal the region. We tell patients not to ice the heel and to stay away from anti-inflammatory treatments or medications. This often requires three to five shockwave treatments every five to seven days or two PRP or amniotic injections a month apart. More than 90 percent of our patients have a resolution of pain with this line of treatment.