Plantar Fasciitis
Ross
Hauser, M.D.
Plantar fasciitis is an
inflammation of the plantar fascia, a thin layer of tough tissue
supporting the arch of the foot that runs from the heel to the
base of the toes. It looks sort of like a series of fat rubber
bands, but the plantar fascia is made of
collagen
which is more rigid and non-stretchy. Repeated microscopic tears
of the plantar fascia cause pain that is most notable in the
morning after getting out of bed. Putting weight on the injured
area after periods of rest (such as sleep) will cause stress on
the area and a more sudden, aching pain. Plantar fasciitis may
also be called “heel spurs,” but this is not always accurate
because bony growths on the heel may or may not be involved.
Plantar fasciitis (piriformis) in runners: Do you realize how
often your foot strikes the ground? In a Runner’s World article,
“A runner’s foot hits the ground about 1,500 times per mile, and
the heel and its attaching tissues bear the brunt of that
force.” Furthermore, “Drastic or sudden increases in mileage,
poor foot structure, and inappropriate running shoes can
overload the plantar fascia, the connective tissue that runs
from the heel to the base of the toes.” At Caring Medical, we
often see runners with plantar fasciitis who may have increased
their mileage too quickly, run on hard surfaces (like the
streets of Chicago), ran in old shoes, overpronate, and/or run
on a sloped surface (such as streets with gutters.)
Development of plantar fasciitis in runners.
The plantar fascia is a layer of ligamentous connective tissue
that runs from the heel bone to the ball of the foot. It not
only maintains the arch of the foot, it is also one of the major
transmitters of weight across the foot as we walk or run. The
stress placed on the plantar fascia is tremendous, and when
inflammation occurs it can be quite painful. The inflammation
can result from excessive stretching, too much pressure or
trauma. If the plantar fascia becomes partially detached at the
heel, a heel spur results. A number of possible causes, often
working in combination, result in plantar fasciitis. They
include tightness of the foot and calf, improper athletic
training, stress on the arch or weakness of the foot. Shoes that
don’t fit, running on hard surfaces, or overuse (running too
fast, too far, too soon) may also be involved. People with low
arches, flat feet or high arches are at an increased risk of
developing plantar fasciitis. We not only see cases of plantar
fasciitis in runners (distance and sprinters), but also in
sports that involve running such as tennis, soccer, football,
etc.
What are the symptoms of plantar fasciitis?
We find that symptoms of plantar fasciitis
can occur either suddenly or gradually. When they occur
suddenly, intense heel pain on taking the first morning steps or
after sitting a long time, known as first-step pain, is usually
involved. The foot tries to heal itself in a contracted position
while the person is sleeping or sitting. Although this heel pain
often subsides as the individual begins to walk around, it may
return in the late afternoon or evening. When symptoms occur
gradually, a more chronic form of heel pain causes individuals
to shorten their stride while running or walking. Individuals
may also shift their weight toward the front of the foot, away
from the heel.
Traditional sports medicine treatment of plantar fasciitis:
The
first line of treatment is usually to recommend that the runner
stop running and then to only gradually begin running again.
Massaging the foot with a tennis ball and application of ice are
commonly recommended. A standard practice of traditional sports
medicine doctors when these things do not work is to inject
steroids into the foot or to prescribe anti-inflammatory
medications in order to relieve the pain associated with
weakened the plantar fascia. Often taping, orthotics, and night
splints are used as well. However, in the long run, these
treatments do more damage than good.
Cortisone shots and
anti-inflammatory drugs have been shown to produce short-term
pain relief benefit, but both result in long-term loss of
function and even more chronic pain by actually inhibiting the
healing process of soft tissues and accelerating cartilage
degeneration. For example, cortisone will eventually weaken the
fascia. If they are not strengthened, a painful heel spur will
result. Plus, long-term use of these drugs can lead to other
sources of chronic pain, allergies, and leaky gut syndrome. Ross
Hauser, MD, wrote a very interesting scientific paper that
appeared in the February 2010 issue of the Journal of
Prolotherapy entitled The Acceleration of Articular Cartilage
Degeneration in Osteoarthritis by Nonsteroidal Anti-inflammatory
Drugs. He also authored
another study entitled The Deterioration of Articular Cartilage
in Osteoarthritis by Corticosteroid Injections that appeared in
the Journal of Prolotherapy in 2009. These articles discuss in
great detail how these two mainstay treatments actually
accelerate the degenerative process for which they are being
given in the first place.
Surgery: Not a good option: When all else fails, patients who
experience chronic foot pain are usually referred to a surgeon.
Unfortunately, surgery often makes the problem worse. Surgeons
will typically use x-ray technology as a diagnostic tool, which
does not always properly diagnose the pain source. Surgery does
not do anything to repair the weakened fascia and ligaments and,
thus, does not alleviate the chronic pain that people with this
condition experience. Therefore, it is not uncommon for us to
see patients post-surgery who are still in pain and still
looking for answers.
Prolotherapy
We find that a better approach for treating plantar fasciitis is
to strengthen the fascia with
Prolotherapy, and provide an arch
support if the condition has remained untreated for years.
Prolotherapy
treatment is the safest and most effective natural treatment
for repairing tendon, ligament and cartilage damage and ending
the chronic pain associated with this troubling condition. In
simple terms, Prolotherapy stimulates the body to repair painful
areas. It does so by inducing a mild inflammatory reaction in
the weakened ligaments and cartilage. Since the body heals by
inflammation, Prolotherapy stimulates healing.
Prolotherapy offers the most curative results in treating
chronic pain. It effectively eliminates pain because it attacks
the source: the fibro-osseous junction, an area rich in sensory
nerves. What’s more the tissue strengthening and pain relief
stimulated by Prolotherapy is permanent!
To learn more about the
Prolotherapy
research and to find
Prolotherapy doctors
Exercise prescriptions: Dr. Hauser, being an avid runner
himself, also guides the runner/athlete through an aggressive
rehabilitation program that includes getting the runner back to
running as quickly as possible. Running on soft surfaces such as
soft tracks can accelerate the process, as well as wearing
proper running shoes. He will also provide the runner with foot
strengthening exercises that will help prevent development of a
recurrence in the future.
