PART II:
TREATMENT AND MANAGEMENT OPTIONS
DIFFERENTIAL DIAGNOSIS: There are other conditions to rule out before assuming plantar fasciitis is the correct diagnosis for the symptoms presenting. Potential issues to rule out include, not limited to- fat pad bruising, Baxter’s Neuropathy, stress fractures, and various tendon strains. It is advised that you do not assume plantar fasciitis treatment with out confirmation of the diagnosis from a physician.
MANAGEMENT: Traditionally, anti-inflammatory medications were prescribed for plantar fasciitis symptoms. The recent research would not support this process due to the nature of the injury not being in acute inflammation. Corticosteroid injections were shown to be no more effective than placebo for pain control and function improvements. NSAIDs are at times utilized for palliative relief but will not help tissue heal for long term relief or proper function.
Multi-modal approaches have repeatedly been supported by evidence-based research and systemic reviews. Exercise, mobilization, and palliative therapies have been shown in combination to have the best outcomes.
Exercises: Strengthening weak musculature related to plantar fascia irritation can help modify agitating mechanics. Exercises can be considered for the gastrocnemius, soleus, posterior tibialis, flexor digitorum brevis, and intrinsic muscles of the foot.
Mobilizations: Checking ankle mobility, big toe dorsiflexion, and working through muscle trigger points can help improve ranges of motion for the lower extremity. Stretching tighter tissues such as hamstrings and the plantar fascia itself have supported significant outcomes and help stress tissue at the histological level for healthy organized repair.
Palliative Therapies: Orthotic supports and bracing in stretched positions can be relieving. Arch wraps can also be considered for support.
Rest: In some cases rest may be necessary for runners. At least modifying the physical activity to find a tolerable level of load is ideal. Once the level is defined, activity should increase by increments no more than 10% per week.
Biomechanics: Cadence modifications can be considered and trained for to minimize overloading the plantar fascia and contribute to minimize reoccurrence.
If you feel you are concerned about symptoms you are experiencing, be sure to connect with a movement specialist physician. There are a list of possible diagnoses to rule out before moving forward with treatment for plantar fasciitis. We hope to be of help for questions, concerns, diagnostics and recovery!
References:
Cobden A, Camurcu Y, Sofu H, Ucpunar H, Duman S, Kocabiyik A. Evaluation of the Association Between Plantar Fasciitis and Hallux Valgus. Journal of the American Podiatric Medical Association. 2019 Nov 12.
Steele, B., & Bertelsman, T. (n.d.). ChiroUp: Conditions Reference- Plantar Fasciitis. Retrieved April 20, 2020, from https://appsv2.chiroup.com/treatment/conditions/53
Michaud, Thomas C., Differential Diagnosis of Heel Pain Dynamic Chiropractic – January 15, 2013, Vol. 31, Issue 02.
Michaud, Thomas C., Injury Free Running: How to Build Strength, Improve Form and Treat/Prevent Injuries. Newton Biomechanics. 2013.
Quillen WS, Magee DJ, Zachazewski JE. The process of athletic injury and rehabilitation. Athletic Injuries and Rehabilitation. Philadelphia: WB Saunders. 1996:4-8.