Plantar Fasciitis is the most common etiology of heel pain. It is responsible for at least 80% of the cases. Two million people in the US suffer from Plantar Fasciitis.
83% are active adults aged 25-65 years old or 4-7% of of the population at any given time.
This condition tends to occur more often in women, runners, dancers and the obese.
10% of all cases are runners.
The cost of treating plantar fasciitis exceeds $300 million each year in the US.
Plantar Fasciitis is not an inflammation at all but a micro-tearing of the tissue at the insertion site at the heel. It is a disorder of the connective tissue which supports the arch of the foot.
The Plantar Fascia is a thick fibrous band of connective tissue. It originates from the medial side of the calcaneus (heel bone) and extends along the sole of the foot and inserts into the base of the toes. Its function is to support the arch of the foot.
What causes this problem?
- Sudden increased physical activity such as running
- Improper footwear such as worn- out athletic sneakers
- Poor foot bio-mechanics called “The Windlass Mechanism”
- Long periods of standing
- Obesity (found in 70% of cases)
- Overpronation of the foot- inward rolling of the foot
- Tight Achilles Tendon
- High Arches
Since it is not an inflammatory condition, studies such as ultrasound and MRI have proven Plantar Fasciitis to be a structural breakdown of the tissue. Small tearing, calcium deposition in the tissue and disorganized collagen fibers cause the pain associated with Plantar Fasciitis.
Disruptions in the normal mechanical movement of the foot when walking or standing place excessive forces on the structure and cause pain at the insertion at the calcaneal area.
- Plantar Fasciitis is usually diagnosed by a healthcare provider with a complete history and physical exam. The pain is usually at the medial aspect of the heel when palpated, dorsiflexion of the foot causes increased pain and typically very tight calf and Achilles tendon is found
- Xrays- can show a heel spur in up to 50% of all cases. However, this is not the cause of the pain
- Ultrasound- Shows a thickened plantar fascia greater than 4.5 mm (normal 2-4mm)
- MRI- usually not necessary unless other causes of heel pain are suspected such as soft tissue tumors, stress fractures, osteomyelitis, tarsal tunnel syndrome, etc.
What else causes heel pain?
The list is extensive and includes:
- Lumbar and Sacral Disc and Nerve Compression
- Metastatic Cancers
- Septic Arthritis
- Rheumatoid Arthritis
- Stress Fractures
- Various Neuropathies
- Plantar Fasciitis usually responds to conservative treatment which can include rest, ice, stretching NSAIDS. (Failure rate with NSAIDS is 20%)
- Physical Therapy- Calf stretching, strengthening exercises, ultrasound and stretching. Orthotic Devices, Shoes, Taping, Custom Orthotics
- Iontophoresis- Topical medications absorbed into the area by the use of electrical current or ultrasound
Injections of Steroids
Corticosteroids injections are commonly used for Plantar Fasciitis resistant to conservative therapy. There have been studies corticosteroids are effective for short-term pain relief. For up to a month but not long term. There are no studies that prove corticosteroids heal the problem. They are anti-inflammatory by definition but this is not an inflammatory disease. Also, corticosteroid use can weaken tissue and since this is a problem caused but micro-tearing in the tissues, It seems counter productive to use this class of drugs. Literature has shown evidence of complications associated with corticosteroid injections such as fascia rupture.
In a systematic review of the literature involving ruptures of the plantar fascia, a total of 155 patients were included 130 of them had been treated with injections of corticosteroids.
Ruptures of The Plantar Fascia: A Systemic Review of the Literature PMID 33307799
Platelet-Rich-Plasma is a concentration of autologous blood products that is bio-active. It causes the deposition of collagen and promotes remodeling of damaged tissue. Since it is autologous, there is no allergic response and is completely natural.
In head to head studies against corticosteroids the initial outcomes measured by VAS scores (Visual Analog Scale is a subjective method as a measure of pain) and AOFAS scores( American Orthopedic Foot and Ankle Score is a quality of life index for foot and ankle cares) measured at 3 weeks, 6 weeks and 6 months, corticosteroids were slightly better initially but Platelet-Rich-Plasma provided better functional results long term.
Platelet-Rich-Plasma does not cause rupture of and tissue and has no systemic side effects such as increasing glucose.
However, in many studies, the amount of the Platelet-Rich-Plasma produced from a sample varied by the process used. The production kit makes a difference.
International journal Foot and Ankle 2:008 doi: 10.23937
Juventix Regenerative Medical Platelet-Rich-Plasma Kit has been FDA approved. The quality and quantity from a single source is reproducible and verified by an independent laboratory. The process is simplistic and outcomes have been verified in thousands of cases nationwide.
The kit used to treat Plantar Fasciitis makes a difference.
Dr. Robert McGrath