Plantar Fasciitis


Plantarfasciitis xray with red ligt

Plantar Fasciitis is a very common problem.  It can be treated very effectively with Platelet Rich Plasma.



Plantar Fasciitis

Plantar Fasciitis is one of the most common musculoskeletal problems involving the foot.  It is caused by degenerative damage to the plantar fascia where it inserts into the heel bone (calcaneus).  About 10% of the U.S. population experience problems related to plantar fasciitis.  Some people refer to the problem as “heel spurs”, but this is really a misnomer.  The heel spur is not the problem.

About 1 million visits a year are made to medical professional per year for this problem.  The pain that develops can be quite debilitating, and can significantly alter daily activity.  

The typical presentation is sharp pain with weight bearing at the front part of the calcaneus.  X-rays can sometimes show a heel spur, but there is no relationship between a heel spur and plantar fasciitis, that is people can have a heel spur and not have any symptoms, and people can have plantar fasciitis and not have a heel spur.  The heel spur is not the problem.

Plantar fasciitis can often resolve on its own, but sometimes this can take quite a bit of time.  It would be nice to try to speed up this process of healing.  PRP injection into the affected area can significantly speed up this healing process.

plantar-fasciitis

Plantar Fasciitis is a common painful problem involving the foot


The Normal Foot and Heel


plantar aponuerosis

The Plantar Fascia is an important supportive structure for the foot.

The foot is obviously critical for us in order to walk normally.  All of our weight has to be supported by it.  This puts quite a bit of force across the foot.  One of the structures that is critical to support the forces across the foot is the plantar fascia.  The plantar fascia is a thick fibrous aponeurosis that starts at the calcaneus (heel bone) and runs out to the ball of the foot (metatarsal head area).  The central part of the plantar fascia is the thickest, strongest, and most important part, but is also the part that gets involved in plantar fasciitis.  The plantar fascia provides tension and support through the arch of the foot.  It functions as a tension bridge in the foot, providing support and shock absorption.  

During walking and especially during running, the plantar fascia and arch are very inportant in shock absorption.  During the heel-off phase of gait, tnesion increases in the plantar fascia, and stores potential energy.  During toe-off, the plantar fascia contracts, converting this potential energy into kinetic energy, accelerating the foot.  It serves a very important function.

The normal, healthy plantar fascia is important for the normal painfree function of the foot.  If the plantar fascia is injured and painful, it will have a very negative effect on the function of the foot.  This can be quite debilitating. 

Treatment should be focused on maintaining the normal functionality of this important structure and getting this important area to heal as quickly and normally as possible.



Plantar Fasciitis


Plantar Fasciitis is a problem invovling the tough supporting structure on the bottom of the foot, the Plantar Fascia, which is a band of tissue that goes from the base of the toes and attaches to the bottom of the heel.  Plantar Fasciitis is caused by repetitive micro trauma to the plantar fascia.  Biomechanical abnormalities of gait, issues such as over-pronation, leg length discrepancies, flat feet or high-arched feet, and poor shoe wear are some of the reasons people develop plantar fasciitis.  Tight and weak muscles of the lower extremity can also be causative factors.  

This repetitive trauma causes tearing of the plantar fascia either along its course or where it inserts into the calcaneus.  If these tears do not rapidly heal, then there will be continued pain with weight bearing.  One of the hallmarks of Plantar Fasciitis is the sharp pain which is at it’s worst with the first few steps in the morning.


plantarfasciitis

Plantar Fasciitis is caused by trauma and tearing of the plantar fascia which does not healing properly and causes pain.


The term “fasciitis” is really a misnomer, since the problem is not an inflammatory problem.  The problem is degeneration and non-healing, not specifically an inflammation problem.  There is often poor blood supply to the area of injury and this prevents the healing process from occurring.  There can be some inflammation present as well, but this is NOT the underlying problem.  And since inflammation in not the underlying problem, treatment should not be focused on decreasing inflammation.  Instead treatment should be focused on getting the injured plantar fascia to heal properly.  Properly focused treatment will allow the area to heal most effectively.  (This is why PRP is a better treatment option, since this is exactly what PRP injection into the injured area does.)


The Problem with Traditional Treatment for Plantar Fasciitis

The Plantar Fascia is an important structure for the normal and proper function of the foot.  Treatment should be focused on preserving and healing the structure fully.

Most Plantar Fasciitis problems can heal and resolve on their own.  It is certainly important to have good shoes that provide adequate support to the arch and reduce impact.  Stretching and strengthening exercises are important.  Physical therapy can be helpful for this.  Sometimes orthotics or special shoe inserts can be helpful.  There are also various contraptions available to buy online (Amazon has 730 different ones available).  And of course, since there are so many, probably none of them are particularly useful.

Some other treatments are not so good.  Corticosteroid injection is not so good.  As we talked about before, plantar fasciitis is not an inflammatory problem.  Corticosteroids reduce inflammation at the injected area.  The problem is that corticosteroids also inhibit healing, weaken the collagen, inhibit stem cells from growing, cause fat and skin atrophy, and are short lived.  None of the things that corticosteroid do is good treatment for plantar fasciitis.  In fact, other than temporarily relieving some pain and inflammation, use of corticosteroids may actually create additional problems in this area.

Surgery for Plantar Fasciitis may not be a good idea in many situations.  The surgery partially or completely cuts the Plantar Fascia (plantar fascia release or fasciotomy).  The problem is that this structure is very important for the stability of the foot.  Cutting this structure can lead to instability of the foot, specifically the medial column, and then causes overloading of the lateral column, which in turn causes more pain in another part of the foot.  People can develop flattening of the arch and decreased feeling in the heel.  These are huge problems and can cause chronic pain in the foot.

Long term results of surgery are often not good, and the use of steroids made the outcome even worse!   (Foot Ankle Int Jan 2016).  This study was done by a group of foot surgeons who noticed that they hadn’t seen the supposed 80% success rate for the surgery in patients.  So they looked at a group of patients and followed them for 10 years.  What the authors found was not very good.  First of all they found that patients who had corticosteroid injections did worse overall.  The patients that had the surgery had a prolonged recovery and generally had poor outcomes.  This led the authors to conclude than plantar fascia release is of questionable clinical value for patients with Plantar Fasciitis.

Another point to make is that a “heel spur” or an osteophyte that is sometimes present on x-rays is not what is causing the problem, so removing the “heel spur” is of no value in most situations.  Don’t treat what doesn’t need to be treated.

So, it is important to realize what the problem really is, and to decide what might actually be the most effective treatment for it.  When the problem is trauma and tearing of a ligamentous-like structure that provided support for the foot, the treatment should be to get that structure to heal back to its normal functional state.  The treatment should avoid things that slow down the healing or that damage that critical structure.  If Plantar Fasciitis does not quickly resolve on its own, then treatment that stimulates the natural healing process should be considered.  This is where Platelet Rich Plasma (PRP) can be a extremely valuable.


Stem Cell and Platelet Rich Plasma (PRP) Treatment for Plantar Fasciitis

Plantar Fasciitis is caused by trauma and injury to the plantar fascia.  This structure is very important for the proper function of the foot.  The Plantar Fascia must heal properly for the foot to have normal, pain-free function.  The problem is that often the Plantar Fascia does not properly or adequately heal and remains painful.  Platelet Rich Plasma (PRP), with its growth factors and cells, stimulates and “kickstarts” teh body’s normal healing process to heal this critical structure naturally.

PRP is far more effective than corticosteroid in treating Plantar Fasciitis  (Foot Ankle Int Apr 2014), and in fact the people treated with PRP had excellent results that were long-lasting.  The study took 40 patients who had heel pain and a diagnosis of plantar fasciitis for at least 4 months and had not responded to conservative care and randomized them to get either a steroid or PRP shot.  The steroid group got about 60% better on a functional questionnaire by 3 months, fell to 40% better by 6 months, were down to 15% better at 12 months, and were even a little worse at 24 months after the shot.  The PRP group tripled their function score (dramatically better-300%) by 3 months and kept almost all of those gains through the first 2 years after the PRP injection.  That is a dramatic difference.  The PRP was more effective and durable than cortisone injection for the treatment of Plantar Fasciits.  This can be explained by the fact that PRP helps the damaged plantar fascia to actually heal rather than just temporarily masking symptoms.

A new study also shows that PRP is as effective in treating resistant plantar fasciitis as Endoscopic Plantar Release.  So PRP treats the chronic problem, that has not been improved by anything else, just as well as the less invasive endscopic plantar release surgery.  (J Ortho Dec 2015).   So why would you want to do the surgery then?  It is best just to treat the plantar fasciitis problem with a PRP injection in the first place.

Don’t let someone inject Corticosteroids into your heel because it is "covered by insurance".  This can cause worsening problems and irreversible damage.  Steroids only temporarily relieve some pain.  PRP can heal the problem!

Platelet Rich Plasma Injection Therapy should be strongly considered for the treatment of Plantar Fasciitis.

This new treatment option is now available to treat Plantar Fasciitis.  Regenerative Medicine and the use of Stem Cell and and Platelet Rich Plasma Injection is a game-changing treatment option that is offered at the Regenerative Medicine and Joint Preservation Center of Santa Rosa.

Call us at (707) 978-4322.  We can talk to you about your problem and what we have to offer to get you better and heal naturally.


Running Trail Feet

Regenerative Injection Therapy with Platelet Rich Plasma (PRP) can treat Plantar Fasciitis and get you back to what you love to do naturally.



©         Regenerative Medicine and Joint Preservation Center of Santa Rosa    2017