What is Plantar Fasciitis?
Your foot has thick, fibrous band of tissue (”fascia”) reaching from your heel to your toes. These tissues support the muscles and arch of the foot. The plantar fascia is a thick connective tissue located at the underside of the foot that supports the arch of the bottom of the foot. The Plantar fascia supports about 14% of the total load in each foot and is highly involved with the biomechanical processes of walking and standing. During weight bearing the plantar fascia acts like a spring to conserve and dissipate energy. During walking, the tension in the plantar fascia increases, due to the dorsi-flexion of the toes, increases the foot stiffness and allows for propulsion of force through the foot. This is known as the windlass mechanism. When overly stretched, tiny tears can occur, causing pain and inflammation. Doctors once thought this type of pain was caused by bony growths called heel spurs. Now they believe that heel spurs are the result — not the cause — of pain from plantar fasciitis.
Generally the solution to this is to try and increase the flexibility in the foot in relation to creating other structures that are able to absorb shock.
About Shockwave Therapy for Plantar Fasciitis
Shockwave therapy for plantar fasciitis and heel pain is applied following a set protocol. The clinician will review your health history in order to understand the clinical history behind the cause of the condition. Proper diagnosis is key to make sure that the condition being treated is actually a plantar fasciitis and heel pain and is therefore treatable with shockwave therapy.
During the assessment, a tender point where the pain is maximal will be located, upon which an ultrasound gel will be applied. This aids the transmission of the shockwave impulses into the desired treatment area. The probe will then be placed over the desired area and then treatment for your plantar fasciitis and heel pain will begin. There is some pain felt over the area of application, which varies greatly from patient to patient. At first the clinician will ensure the discomfort is kept to a minimum by adjusting treatment settings to your comfort or tolerance level. Shockwave Therapy has a natural analgesic effect, so the intensity of sensation felt decreases as the treatment continues.
After treatment you should feel very little pain and this may last for a few days. After then an aching sensation can occur.
After subsequent treatments there will be a definite improvement in symptoms leading to reduction in the original pain felt.
How many Shockwave Sessions are Typically Needed?
Treatment of Plantar Fasciitis with Shockwave Therapy generally required 3-5 treatments of about 20 minutes each. This can depend on the exact presentation of symptoms and the patients level of tolerance for receiving the treatment. For example, if the first couple treatments need to be at a significantly lower intensity due to pain, then addition treatments may be required. Making sure you see someone quickly to have the condition diagnosed can reduce the number of sessions needed.
It is vital that you continue to work with your therapist to maintain the exercise routine you should already be doing for plantar fasciitis. There is likely a biomechanical dysfunction that caused over loading of the plantar fascia in the first place, which need to be addressed. If the underlying cause is not addressed, it is more likely that the pain and dysfunction could return in time.
What is the evidence for shockwave therapy for plantar fasciitis?
Although there has been little positive scientific for treatments which are beneficial for plantar fasciitis there does seem to be a growing volume of literature, all of which are drawing the same conclusions. The most effective non-operative treatment for plantar fasciitis appears to be shockwave therapy (Aqil 2013, Cutts 2012)
Saxena 2012 compared shockwave therapy to surgery and agreed that the outcomes for return to sport and continuation of sport whilst undergoing treatment were in favour of shockwave therapy for plantar fasciitis. Although, Endoscopic plantar fasciotomy (operations) were superior in outcomes but with the associated risks. Athletes were able to have shockwave therapy and maintain playing their chosen sport, whilst the surgical group had to stop playing sport.
Vahdatpour 2012 produced a study, which showed the morphological changes associated with shockwave therapy for plantar fasciitis. Most studies also show that, alone, the shockwave therapy can reduced significantly pain and suffering associated with plantar fasciitis but it is clear that biomechanical factors need to be addressed and maintained to allow optimal functioning of the foot during weight bearing.
Shockwave Therapy at Remedy Wellness Centre
Shockwave Therapy is available at Remedy Wellness Centre with our chiropractor or physiotherapist. It may be covered by your extended health plan. If you are unsure, we recommend you call your provider for details.
What other treatments are available for plantar fasciitis and heel pain?
There is little scientific evidence about the types of treatments that help plantar fasciitis. New research into shockwave and its applications has been very positive and gives sufferers of this painful condition hope. Other possible treatments for plantar fasciitis include;
- Corrective exercises
- Ice Massage
- Night Splinting
- Self Massage
- Heel Pads
- Steroid Injections
- Surgical Release
- Pain killers
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