I feel so frustrated and impatient. The conservative approach to healing plantar fasciitis includes: (1) Not running, (2) Orthotics, (3) No bare feet, (4) Cold packs several times per day, (5) Calf stretches, (6) Towel stretches, (7) Night splints, and (8) Arch massage with a tennis ball under the foot. I've done all of those things, though I did run a short distance last Saturday, stopping when the heel started to ache. All in all, though, conservative treatment hasn't worked; the injury is still there.
I think about running through it, like I did in Grandma's Marathon. Just run in spite of the pain and keep up the other treatments, hoping that the problem will eventually resolve. But running with this level of pain is not enjoyable; I need to find another approach.
Two interesting-sounding treatments are suggested on some web sites:
Low Intensity Laser Therapy:
Infrared light at a low energy level is applied to the injury. In theory, the right wavelength of monochromatic light at the right intensity can somehow aid tissue regeneration. The treatment is repeated several times or until the pain resolves. A one-page article in Runner's World, August 2007, p. 46, details the successful treatment of one runner.
In an internet search, however, those who sing the praises of low intensity laser therapy (LITL) tend to be those who profit by its use. Disinterested reports are not so rosy. I was unable to find any high-quality studies that clearly demonstrated the benefits of LITL.
I did, however, find a 1998 study by Mayo Clinic concluding that LITL has no benefit for the treatment of plantar fasciitis. Further, I found a 2004 PDF document by the state of Washington which referred to a 1995 study suggesting that a placebo was slightly better than LITL.
Maybe it works for some runners, maybe I missed some recent research, maybe not, but count me out for now.
Extracorporeal Shock Wave Therapy:
High-intensity ultrasound is applied to the injury. How does it work? Two theories: (1) The ultrasound creates microtrauma, permitting new blood flow to promote healing, and (2) The ultrasound somehow reminds the brain that this area needs attention, and the brain renews its forgotten attempts to heal the area. This treatment is actually FDA approved for the treatment of plantar fasciitis.
Unfortunately, again, I found no high-quality studies demonstrating any benefit. The Journal of Orthopedic Research and the British Medical Journal (reporting on a German study) both found no benefit for plantar fasciitis. Another German study, however, did find some benefit when treating calcific tendinitis of the shoulder.
Nevertheless, I won't seek out this treatment either, unless recommended by someone whose opinion I trust more than mine.
In that regard, I have an appointment with a sports-medicine podiatrist in Stillwater next Tuesday. Meanwhile I am changing my treatment protocol from ice to mostly heat, which (according to me) promotes healing. I will apply ice if I re-injure it, then later apply heat again.
Good Resources:
- Heelspurs.com: A rather complete reference for plantar fasciitis.
- SportsInjuryBulletin.com: Describing an exercise plan which the author believes will relieve the underlying cause of plantar fasciitis. Much of this I have not tried.
Dessert:
Cantaloupe, organic yogurt, blueberries, blackberries, organic grapes, organic nectarine, on the picnic table. Estimated Weight Watcher points = 4.
14 comments:
Hope things start getting better. I've had it before where I've had to take a few weeks off from running because of it so I know how frustrating it can be!
Don,
I'm impressed by your initiative. I think you've done the right thing in researching the scope of treatments available to you.
I've posted a response to your analysis of LILT on my blog at: http://www.laserevangelist.com/2007/07/treating-plantar-fasciitis-with-low-intensity-laser-therapy.php. Included are links to three compilations of medical studies supporting LILT in this treatment. As a bonus, I included a link to an article on laser.nu reviewing negative studies on LILT.
I'm eager to hear your thoughts!
Thanks evangelist,
I have an appointment with a podiatrist on Tuesday, so I'll hold off LILT until after that.
don-
I have received Low level Laser treatments from my chiropractor for a couple of injuries in the past. I didn't undergo a "series" of treatments just a few isolated ones and it seemed to help me. I asked them today their thoughts on laser treatments regarding plantar facia and if indeed you have true plantar fasciitis it should help. She also mentioned that there are a few different lasers out in practice that have different strengths of power. the laser my chiro's use are of the highest power. go to www.erchonia.com and check it out. the treatments are not cheap and not covered by insurance but can be very beneficial. Best of luck and keep up the good work. By the way, have you tried aqua jogging? it is a great way to stay in running shape with no impact on your foot at all.
Gregg
Gregg,
Thanks! I appreciate that you asked them that question. I may yet get around to trying LITL.
I have done water jogging and find it can be as aerobic as anyone might want. Maybe I should try it again, since I'm having knee trouble on the bike.
Don
Erchonia gets a lot of press, but don't necessarily make the best laser devices. There is much more involved in LILT than the assumed power output. Parameters such as wave form, frequency, duty cycle and power all combine to deliver the correct treatment. It's not as simple as shining a light on the area that hurts. Also, some pathologies require treatments outside of the impacted area (ex: often achilles tendonitis requires treatment of the low back as well as the achilles).
The Erchonia PL3000 has one 5mw diode. Compare that to other systems like the Theralase with average output of 100mw, or a MedX cluster with 49 diodes, or a Meditech system that can have up to 179 diodes in an array.
Have you tried massage for it? Good sports massage might be able to help it (beyond the tennis ball massage).
I'm eight months into my recovery plan with virtually no running up until the last few weeks. Now I finally feel like I am turning the corner, and I am gradually beginning to run again. Initially I was hyper-committed to all types of stretching, and looking back I feel that I overdid it. After many months of continued pain, I reduced to a more moderate, gentle stretching program, which helped more. It was hard to ratchet down my recovery program because of my personality, but I think my foot just needed some extra TLC. Also, I had been using a squash ball under my foot, but switching to a golf ball was definitely better for me, because of the extra hardness and the dimpled surface. Hope some of this helps.
Danielle, John,
Thank you very much! Things to try ...
Hello,
I am also suffering from plantar fasciitis, for a year now actually. I've tried the low laser soft tissue therapy and the ultrasound therapy through seperate chiropractors under orders of my work doctor. My PF is caused by working 12 hour shifts in work boots on cement floors.
Anyways I've found that both relieve the pain enough for me to go to work and not be crippled the next day but they certainly are not a cure.
Also both chiropractors and my doctor have said the splints are not something that they have ever seen work in any case of PF.
I have an appointment with an Orthopedic surgeon in the morning and we shall see what he recommends... probably surgery which I dread but a year with this pain has caused me to rethink it. It has only been getting worse for me over the year despite the icing and stretching and treatments.
I did a little research on endoscopic plantar fascia release surgery which is mostly non-invasive, done with a camera and tiny incisions. This has less recovery time I am told but could possibly cause more small nerve damage, though studies dont currently back that.
Good luck to you on your journey to recovery.
I have had PF on and off for over five years. I just kept running on it until 9 moths ago when it became unbearable to run anymore. I have not run in 9 months. I have tried every protocol in this time. Stretching, PT, massage, ultra sound, rest, night splint, and 3 cortisone shots Out all this, the only thing that helped was the cortisone injections. This got my foot to about 90 percent. I still have "twinges" of pain in the heal. I'm not going to run until it completely subsides. I am going to get laser treatment in two weeks. I'm desperate and will try anything at this point. I think for persistent health problems like this, you have to keep experimenting, changing one variable at a time, until you come up with a solution.
Notice these postings are quite old but thought I'd add my two cents. I have had PF for ten years although with orthopedic inserts and icing occasionally the pain was manageable. This spring I had a "flare" in my left heel that was unbearable. It would not go away. I've seen a podiatrist, a physical therapist (PT), a massage therapist (MT), and a muscle activation therapist (MAT). To make a long story short I've tried cortisone which was short lived, Aleve which eventually damages the liver, prescription pain killers that gave me nausea and stomach cramps, ice for inflammation, heat to promote blood flow, massage with a dryer ball under arch, various foot and leg stretches, ultrasound, electric current, orthopedic inserts, extra inserts, no inserts, and new and different shoes. Currently I am seeing a chiropractor who is using cold laser to treat inflammation and active release therapy (ART) to break up the scar tissue. This is extremely painful but seems to be working after three treatments when nothing else would. The podiatrist wants to operate to release the tendons. I do not see how this would help as it would create even more scar tissue at the sight of injury and I'm absolutely opposed to it. Hoping the chiropractor can continue to work her magic but if not my last recourse is acupuncture. It is the only thing I haven't tried.
Hi
Thanks for the insight. I am a teacher and have had PF for two years - tried inserts, icing, shots, meds, etc. Finally podiatrist said to try PRP. I did that on Dec. 27th 2010. After three weeks in a foot cast and another two weeks in a tight wrap along with PT, I do think my heel is better. BUT now I have extreme pain in the arch and around the toes. I ask my podia WHY? Did the PRP cause this??? (Second podia I have been to). No really answer. Now he wants me to try the cold laser therapy. I cannot work without extreme paid and am getting desperate. Did anyone have better luck with the PRP injection??
Nancy
Hi Nance,
My problem went away by itself, with a big pain when something broke in the fascia. Two days later I was fine.
Before that, I got the most relief from the Strassburg Sock, which I wore every night. I know nothing about PRP.
I also went to two podiatrists, neither of whom were of any help.
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