CASE STUDY

INDICATION: Plantar Fasciitis

DESCRIPTION

Plantar Fasciitis is a serious, painful, and progressing condition that occurs when the long, flat ligament along the bottom of the foot develops micro-tears and inflammation. In other words, plantar fasciitis is a strain of the plantar ligament. The plantar ligament extends from the five toes and runs along the bottom of the foot, attaching at the heel. When you walk or run, you land on your heel and raise yourself on your toes as you shift your weight to your other foot, causing all your weight to be held up by your plantar ligament. Under certain circumstances, such repetitive force can damage the plantar ligament.

         Many factors can cause plantar fasciitis to develop. When walking with a normal step, the plantar ligament stretches as the foot strikes the ground. When walking with an abnormal step, or when putting repetitive pressure on the heel, the plantar ligament can stretch irregularly, become stressed, and develop small tears. These small tears can cause the ligaments outer coating, or fascia, to become inflamed and can lead to serious pain.

         The pain from plantar fasciitis is described as being either dull aching or sharp, and it can usually be reproduced by flexing the toes upwards (dorsiflexion) and tensing the ligament. Plantar fasciitis pain tends to be worse after standing or exercising for prolonged periods or after getting out of bed in the morning. Morning heel pain from plantar fasciitis is one of the most common symptoms and occurs because the fascia becomes tense after a protracted rest. As the person walks, the ligament “warms up” and lengthens slightly, reducing the tension on the ligament and lessening pain.

TREATMENT

Plantar fasciitis has typically been very responsive to Low Level laser Therapy (LLLT) using the Laserstim 1500 system. Treatments should commence as soon as possible.

During the first week, 2-3 LLLT treatments are recommended. In very acute cases (often involving elite teenage or adult athletes), a more intense regime of 3 consecutive daily treatments followed by another treatment on day 5 is optimal. During the second week, 2-3 treatments should be done on alternating days. This usually alleviates the condition. When plantar fasciitis lingers into a third or fourth week, only 2 treatments per week are required.

When treating plantar fasciitis, LLLT should be accompanied by a diligent progressive stretching program. When practical, strenuous exercise or work affecting the feet should be avoided until the pain subsides for several days. Thereafter a gradual build-up is recommended.

In addition, the underlying causes of plantar fasciitis must be addressed to prevent re-occurrence. Preventative measures include:

• Maintain a healthy weight. This minimizes the stress on the plantar ligament.
• Choose supportive shoes. Give stilettos the boot. Also, avoid shoes with excessively low heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don't go barefoot, especially on hard surfaces.
• Don't wear worn-out athletic shoes. Replace old athletic shoes before they stop supporting and cushioning your feet. Runners should consider buying new shoes after about 400 miles.
• Orthotics. ¾ or full length orthotics shoe inserts, especially those with graphite arch supports and gel cushions, help distribute pressure across feet more evenly and massage the plantar ligament. Both custom and over-the-counter inserts have proven effective.
• Start sports activities slowly. Warm up before starting any athletic activity or sport, and start a new exercise program slowly.
• Wake up with a stretch. Before getting out of bed in the morning, stretch your calf muscles, arch and Achilles tendon by reaching for your toes and gently flexing your foot. Then massage the plantar ligament. This helps reverse the tightening of the ligament that occurs overnight.
• Daily stretching regime. Several times a day, at-risk individuals should perform a simple series of exercises than stretch the plantar ligament and Achilles tendon and strengthen lower leg muscles. This helps stabilize the ankle and heel. Some individuals may also need to apply athletic taping to support the bottom of their foot.

COMMENTS

As stated above, our clinical results treating plantar fasciitis have been consistently excellent. It’s also not unusual that plantar fasciitis patients concurrently develop Achilles tendonitis from attempting to walk more on their toes. In those situations, both areas are treated concurrently.

It must be emphasized that LLLT accelerates the natural soft tissue healing process. While plantar fasciitis patients often experience dramatic pain relief in just 2-3 treatment sessions, the treatments should continue for at least two weeks to assure a complete recovery. Likewise, athletes should refrain from competition and training long enough for healing to complete.

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