Plantar Fasciitis

Plantar fasciitis

Conditions Treated:

The plantar fascia is a flat strand of ligamentous tissue which connects the heel bone to the toes. It is responsible for the arc shape of the foot.

Causes of Plantar Fasciitis

When the plantar fascia is strained it can weaken and swell. A cycle of fascial injury and tearing can occur which may lead to a chronic case of plantar fasciitis with associated chronic pain. Plantar Fasciitis is primarily caused by stretching and tearing of the ligamentous tissue of the plantar fascia.

Symptoms of Plantar Fasciitis

Plantar fasciitis is typically felt as a sharp, stabbing pain in the sole of the foot in or around the heel and is the most common cause of heel pain in adults. The pain usually occurs in the morning when taking your first steps, while resting after physical activity or after standing for prolonged periods of time.
Symptoms may also appear as stiffness and pain in the heel at the beginning of physical exercise which improves as exercise continues only to return when exercise is completed. Plantar fasciitis may be mistaken for osteoarthritis as the symptoms of pain and stiffness are similar.

Plantar Fasciitis Risk Factors

There are a number of factors which can increase a person’s risk of developing plantar fasciitis:

  • Increased age
  • Personal or family history of arthritis
  • Recent weight gain or being chronically overweight
  • Tightness of the Achilles tendon or calf muscles
  • Activities that increase physical stress on the feet, such as unconditioned running, change of running surface, wearing poorly cushioned shoes and prolonged standing on hard surfaces

Diagnosis

Diagnosis of plantar fasciitis is based on history taking and physical exam. Generally an X-ray will not be required unless a fracture is suspected or to rule out osteoarthritis. In rare cases an MRI might be required to confirm the diagnosis of plantar fasciitis.

Plantar Fasciitis Treatment

The goals when treating plantar fasciitis are to:

  • Relieve heel pain
  • Allow tears in the plantar fascia ligament to heal
  • Improve strength and flexibility
  • Correct structural problems such as excessive pronation which stress the tissue of the plantar fascia
  • Achieve enough recovery to allow return to usual activity level

The vast majority of cases of plantar fasciitis do not require surgical treatment. Conventional treatment for plantar fasciitis may involve a rehabilitative exercise protocol, wearing supportive footwear and improving ergonomics.

Platelet-Rich Plasma Injections

PRP treatment plantar fasciitis
Platelet-rich plasma (PRP) is a treatment which uses a component of a person’s own blood in order to initiate healing of injuries and painful chronic conditions. A person’s blood is collected and centrifuged on the day of treatment. The platelet-rich layer of the centrifuged blood is collected and used for injection. PRP is a safe treatment which can provide significant relief to people with plantar fasciitis including reductions in pain, improved mobility and a return to usual daily activities.

PRP injections contain a high concentration of growth factors which are naturally present in our platelets. Our natural response to injury includes directing platelets rich in growth factors to the site of injury. These growth factors are released from the platelets and trigger our healing response, initiating repair of damaged tissue. In cases of plantar fasciitis the damaged or partially torn plantar fascia can be repaired with the use of PRP injections.

Platelet-Rich Plasma Research

Twelve clinical trials have investigated the use of platelet-rich plasma injections for the treatment of plantar fasciitis. All twelve of these trials found a significant benefit on plantar fasciitis with PRP treatment1-12. Six of the trials compared PRP to cortisone injections and all six of these trials found that the PRP treatment was more effective than a cortisone injection1-6. The mechanism of action of PRP in the recovery of plantar fasciitis is proposed to be through encouraging healing of the torn or damaged ligamentous tissue of the plantar fascia8.

References

  1. Say F, Gürler D, İnkaya E, Bülbül M. Comparison of platelet-rich plasma and steroid injection in the treatment of plantar fasciitis. Acta Orthop Traumatol Turc. 2014;48(6):667-72.
  2. Shetty VD, Dhillon M, Hegde C, Jagtap P, Shetty S. A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: a preliminary report. Foot Ankle Surg. 2014 Mar;20(1):10-3.
  3. Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int. 2014 Apr;35(4):313-8. doi: 10.1177/1071100713519778.
  4. Mahindra P, Yamin M, Selhi HS, Singla S, Soni A. Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo. Orthopedics. 2016 Mar-Apr;39(2):e285-9.
  5. Jain K, Murphy PN, Clough TM. Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study. Foot (Edinb). 2015 Dec;25(4):235-7.
  6. Akşahin E, Doğruyol D, Yüksel HY, Hapa O, Doğan O, Celebi L, Biçimoğlu A. The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis. Arch Orthop Trauma Surg. 2012 Jun;132(6):781-5.
  7. Kim E, Lee JH. Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis. PM R. 2014 Feb;6(2):152-8.
  8. Martinelli N, Marinozzi A, Carnì S, Trovato U, Bianchi A, Denaro V. Platelet-rich plasma injections for chronic plantar fasciitis. Int Orthop. 2013 May;37(5):839-42.
  9. van Egmond JC, Breugem SJ, Driessen M, Bruijn DJ. Platelet-Rich-Plasma injection seems to be effective in treatment of plantar fasciitis: a case series. Acta Orthop Belg. 2015 Jun;81(2):315-20.
  10. Vahdatpour B, Kianimehr L, Ahrar MH. Autologous platelet-rich plasma compared with whole blood for the treatment of chronic plantar fasciitis; a comparative clinical trial. Adv Biomed Res. 2016 May 11;5:84.
  11. Gogna P, Gaba S, Mukhopadhyay R, Gupta R, Rohilla R, Yadav L. Plantar fasciitis: A randomized comparative study of platelet rich plasma and low dose radiation in sportspersons. Foot (Edinb). 2016 Aug 5;28:16-19.
  12. Chew KT, Leong D, Lin CY, Lim KK, Tan B. Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomized trial. PM R. 2013 Dec;5(12):1035-43.
Dr. Colin MacLeod ND

Dr. Colin MacLeod ND

Naturopathic Doctor at MacLeod Naturopathic
Dr. Colin is a naturopathic doctor practicing in Upper Tantallon in the Halifax Area. He was born and raised in rural Cape Breton, Nova Scotia and always knew he would return to Nova Scotia after finishing his naturopathic education in Toronto. His clinical focuses include pain, athletic performance and digestive issues. He utilizes platelet-rich plasma, neural prolotherapy, prolozone and acupuncture to help alleviate his patients' pain.
Dr. Colin MacLeod ND

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Last updated Sep 25, 2016