Therapy Combinations for Plantar Fasciitis

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Fact-checked & edited by Dr. Helen Okoye, MD, MBA, MS-Epi

Plantar fasciitis is a condition that can affect a person’s overall quality of life, as it can lead to severe heel pain and prevent even simple activities, such as walking, from happening. In deciding on the management of this condition, the majority of medical specialists prefer to use therapy combinations, rather than rely on a single approach.

In this article, we will discuss about these therapy combinations and how efficient they actually are, in reducing the severe pain heel and other symptoms associated with plantar fasciitis.

Therapy combinations for professional runners

plantar fasciitis areas of pain
If you are a professional athlete who suffers from plantar fasciitis, the main idea is that you recover as fast as it is possible (so that you can return to proper training and take part in competitions). The therapy combinations[1] recommended for this condition depend on the symptomatology exhibited.

In the acute phase, the most important thing is that you rest the affected foot, in order to reduce the pain and inflammation. The more you rest, the lower the intensity of the morning pain is going to be (thus, allowing you to walk). In general, it is recommended to avoid the activities that are highly likely to add to the existent pain. You need to stay off your feet and use crutches, in order to relieve the pressure off the plantar fascia.

Medical specialists recommend that, during the acute period, the patient wears only comfortable footwear, preferably cushioned. At the same, one has to avoid walking barefoot, as this can aggravate the condition. Cold therapy is highly recommended, either as ice massage or cold pack applications. In the first day, the cold application should be maintained for ten minutes and repeated every hour. As the symptomatology improves, the application can be reduced to several times per day.

In order to protect and support the recovery of the plantar fascia, one might decide to use kinesiology taping. NSAIDs, most likely ibuprofen, are administered, in order to guarantee further relief from the pain and inflammation. It is important to take such medication exactly as recommended, so as not to suffer from unwanted side-effects.

Orthotic inserts are recommended to be worn at all times, as these can correct the excess pronation and reduce the pressure on the plantar fascia. During the night, it is indicated to wear splints, for as long as it is possible. You can also try water physical therapy; even in the situation of intense pain, movements are easier performed under water, as there is no gravitation to fight. Last, but not least, you can visit the physical therapist for gentle stretching. This specialist will work on your plantar fascia, as well as on the calf muscles and tibial anterior muscle, as much as your current level of pain allows.

As the acute phase subsides and you begin to recover, it is recommended to maintain the cold applications, especially after you have engaged in physical exercise (walking included). Massage therapy can be used, in order to stretch the plantar fascia and improve the overall symptomatology (at first, only a gentle massage is recommended; you can increase its intensity, as the inflammation subsides). As an alternative to massage, you can roll your foot over a ball/rolling pin (for about ten minutes per day).

The physical therapist will continue with stretching exercises, as these can help the plantar fascia to heal a lot faster. The night splints should be worn for at least five hours per night. As the pain has probably subsided by now, it is recommended to begin walking, increasing the amount gradually, until you reach half an hour per day.

Once the symptomatology has been brought down to a minimum, it is time to get back to running. Maintain the cold application after each training session and do your stretches, exactly as the physical therapist has shown you. The return to running should be made on a gradual basis. Between walking and jogging sessions, make sure you get plenty of rest, so as not to irritate the plantar fascia and return to more serious problems.
Rocker soles & foot orthoses

A study[2] that was published in Clinical Biomechanics and also on Healio O&P News, presented the combination of rocker soles and foot orthoses as highly efficient in relieving the intense heel pain caused by plantar fasciitis. The participants to the study were asked to wear different types of footwear, including: baseline shoes (flat insoles or custom-made orthoses) and rocker shoes (flat insoles or custom-made orthoses).

After the selection of footwear was made, the participants to the study were asked to engage in walking trials. Researchers measured the intensity of the heel pain they experienced, upon using the chosen footwear. At the same time, with the help of a pressure insole system, they analyzed the distribution patterns of plantar pressure. The study revealed that the lowest heel pain was present in patients who used rocker shoes and custom-made orthoses. These were the ones who also had the most uniform distribution pattern of plantar pressure.

Taping & iontophoresis

taping plantar fasciitis
A study[3] that was published in the Journal of Exercise Science and Physiotherapy presented the combination of kinesiology taping and iontophoresis as being effective for the treatment of plantar fasciitis pain (in comparison to either method being used on their own).

Kinesiology taping can be used in patients who suffer from plantar fasciitis, in order to take pressure off the plantar fascia. The application is easy to perform and it can be maintained at all times, including when it comes to standing or walking.

Iontophoresis is a form of therapy that involves the application of electric impulses, using galvanic current (low-voltage). The stimulation of the soft tissues occurs, as the ions penetrate the skin and reach said structures.

According to the results of the study, the combination of kinesiology taping and iontophoresis proved out to be quite effective, reducing both the pain and stiffness associated with plantar fasciitis. This combination can be used in both acute and chronic cases, causing a great improvement whereas the “first-steps” morning pain is concerned.

Shockwave & laser therapy

According to a study[4] undertaken by a team of multidisciplinary specialists, the combination of shockwave and laser therapy could be efficiently used for the treatment of plantar fasciitis and other inflammatory conditions (in comparison to shockwave alone). Apart from plantar fasciitis, the study concerned lateral epicondylitis and calcar calcanei.

The participants to the study were divided into two main groups. The first group received only shockwave therapy, while the second benefitted from a combination of shockwave and laser therapy. The intensity of the pain experienced after the treatment was assessed with the help of a questionnaire. The study concluded that the combination of shockwave and laser therapy is more effective when it comes to dealing with plantar fasciitis pain (in comparison to shockwave therapy being used on its own).

Shockwave therapy is beneficial for patients with plantar fasciitis, it has an analgesic effect and, at the same time, it can stimulate the circulation in small blood vessels. It is also known to reduce the muscle tension associated with this condition, as well as eliminate calcified fibroblasts and stimulate the production of collagen.

Laser therapy is well known for its anti-inflammatory and analgesic properties, being able to stimulate the production of beta-endorphins. It can also stimulate the restructuring of collagen tissue, contribute to the regeneration of blood & lymph vessels and it can reduce edema associated with plantar fasciitis. Last, but not least, laser therapy can reduce the tension experienced in the plantar fascia, reducing the intensity of the heel pain.

Night splints & foot orthoses

More and more researchers are trying to come up with efficient therapeutic combinations for patients who suffer from plantar fasciitis. According to a study[5] undertaken by Hong Kong specialists and published online, the best results are given by a combination of night splints (with adjustable dorsiflexion) and foot orthoses (custom-made, accommodative).

The participants to the study were asked to wear both the night splints (soft & self-adjustable) and the foot orthoses (custom-made for each study participant). The pain and overall level of functioning were appreciated with the help of the Foot Function Index Questionnaire. The assessments were made right before the study, at two weeks after the study had concluded and, also, once more, after eight weeks from the study.

It was revealed that the participants who used both foot orthoses and night splints presented the lowed pain scores. Researchers recommend that patients benefit from custom-made orthoses, as well as from night splints that are self-adjustable and made from soft materials (neoprene). These conservative measures can take off the pressure from the plantar fascia, allowing the patient to recover and experience significantly less heel pain.

Final word

As you have seen, there are numerous therapeutic combinations recommended for patients who suffer from plantar fasciitis. Every day, more and more studies are undertaken, in order to reveal the most efficient combinations and help patients recover from this condition, as quickly as it is possible.

References:
[1] http://www.sportsinjuryclinic.net/sport-injuries/foot-heel-pain/plantar-fasciitis/plantar-fasciitis-rehabilitation
[2] http://www.healio.com/orthotics-prosthetics/orthotics/news/print/o-and-p-news/%7Ba0960a55-a089-4bdb-b497-bb4739e359d8%7D/rocker-sole-foot-orthoses-combination-relieves-plantar-fasciitis-pain
[3] http://medind.nic.in/jau/t13/i1/jaut13i1p34.pdf
[4] http://ondedurto.net/hcms-content/file/SWT+laser_study-v2.pdf
[5] http://www.rehab.research.va.gov/jour/2012/4910/pdf/lee4910.pdf


About the Author Amy Williams

Amy is a foot massage therapist that has worked with doctors specializing in podiatry while helping numerous clients through various foot conditions. She has reviewed 100s of related foot health products for plantar fasciitis, toenail fungus and more.

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