How to Use Conservative Therapy to Treat Plantar Fasciitis

Houston podiatrist discusses conservative care for plantar fasciitisThanks for joining me for my third installment on my video series on plantar fasciitis. In my previous videos, I discussed what plantar fasciitis is, what it's caused by, and how it's diagnosed. Plantar fasciitis is one of the most common conditions I see in my podiatry practice and is a very common cause of heel and arch pain. In today's video, I'm going to discuss conservative care for plantar fasciitis. Now there's a lot, but you don't do it all at once, but different things work for different people. And that's why there's going to be a lot to discuss. Welcome, I'm Houston podiatrist, Dr. Andrew Schneider

I find that people are reluctant to come into the office to get their plantar fasciitis or their heel pain checked for the fear of surgery. I can tell you that 95% of cases are managed without surgery at all. All we need is conservative care. I have so many patients who kick themselves for not coming in sooner because we're able to manage their heel pain much easier than they thought would be possible.

Since the pain of plantar fasciitis is due to inflammation, our first step is to address that inflammation. And we do that through a few different means. Number one is we can use a cortisone injection. Cortisone is an anti-inflammatory and we would be injecting it right into the area of the inflammation. That's usually the quickest pathway to getting your pain under control. And most people choose that as a first line of treatment, others will choose to use oral anti-inflammatories. 

While the benefit of oral medication is that it's not an injection, the negative is it doesn't just go to the foot that's bothering you. It goes throughout your entire body. Even so, it is a way that we're able to control the inflammation and get you feeling better. I also may recommend a topical anti-inflammatory. This might be a prescription, or this might be over the counter, but it's actual anti-inflammatory medication in a topical form that will penetrate to the structures. The nice thing about our foot is there's not much between the skin and the bone, just some soft tissue that's inflamed. So it's going to penetrate well and you should feel some good relief from a topical anti-inflammatory. And let's not forget about simple ice. Ice is a great way to manage inflammation, but when you use ice, don't use it more than 20 minutes at a time, it gets too cold and will actually cause a rebound inflammation. So 20 minutes on 40 minutes off. It really works well for plantar fasciitis.

If you remember back to one of my earlier videos, I said that inflammation was just one piece of the puzzle. The other piece is mechanics, the way that your foot functions. And your foot will typically have unstable mechanics, which is what allows this inflammation to persist. So we're going to address your unstable mechanics. We'll use some medical grade insoles that we have here at the office to be able to, stabilize the bottom of your foot. I may apply a strapping of tape to the bottom of your foot to serve as some extra stabilization for a few days, especially after I give you an injection. And I'm also going to show you some techniques to stretch with a foam roller. People use different things to stretch with, with a lacrosse ball or wooden roller. I like foam rollers, the best they conforms to the bottom of the foot. They give the best stretch, and I think people do the best with them.

What I described was just the first line of treatment. Future treatments may include custom orthotics. A custom orthotic is a custom insole that's made to provide stability and efficiency to your feet. Now the medical grade insole that I may have already dispensed is there simply to support the arch, to help to stop the pull of that ligament. A custom orthotic is designed to be corrective just in the same way that eyeglasses are corrective. When I wear my eyeglasses, I can see without squinting, when I take my glasses off, I can't. And it's the same thing for a custom orthotic. When you wear a custom orthotic, it's going to allow your feet to work in the most efficient manner. When you take them off your feet, it'll revert back to the way they are. It's the best long-term treatment after we get the inflammation under control to help to prevent that inflammation from coming back in the future. So a custom orthotic is usually in our arsenal to fight plantar fasciitis.

I may also recommend a stretching splint. This is a light brace that you wear at night, some people call it a night splint, to help to keep a stretch on your plantar fascia. It prevents that ligament from contracting over the course of the night. And when you step out of bed, it helps to prevent that searing pain that you feel when do those with those first steps in the morning. Some people love it. Some people have trouble sleeping in it, so I have a work-around if that's the case. That's our next step in trying to get this, plantar fasciitis under control.

I also may discuss injections of using regenerative medicine. Regenerative medicine is different from the cortisone injection that I discussed, that was anti-inflammatory. Regenerative medicine is an injection of platelet, rich plasma, Amniotic stem cells or exosomes. And what these things do is help to decrease the inflammation, but also help to repair the tissue. The treatment is slowly taking the place of cortisone injections. Why is it slowly? Well, you can imagine things like this are expensive and insurance companies are a little bit slow in picking up payment for these types of injections, but we're definitely seeing movement in the right direction. And we may discuss this as being the right option for you.

Another conservative treatment for plantar fasciitis is shockwave therapy. Shockwave therapy is what it sounds like: thousands of shockwaves are sent into the area of inflammation, usually into your heel. It increases the blood circulation to that area, kind of creates micro injuries to attract the blood flow to that area, and helps to accelerate the healing process. It's usually three to five treatments a week apart, and each treatment is less than 10 minutes. The people who have had shockwave therapy have reported great results with it, and in certainly will be very useful, especially if your plantar fasciitis is not resolving as we like it to.

Finally, I might also send you for physical therapy. I work with a great physical therapy group who really helps my patients get better. It's helpful because it helps increase the mobility of the foot. The physical therapists use modalities to reduce the inflammation of the plantar fascia. And they'll also work with you on a stretching or strengthening program to help to prevent plantar fascia from coming back in the future. There are some people have mixed feelings about physical therapy. Personally, I think it serves a great purpose for those people who need it.

Thanks for watching this video about conservative treatment for plantar fasciitis. In my next video, we're going to discuss how plantar fasciitis is treated with surgery. The other 5% of the time for those people who are not served by conservative care. If this video served you and provided value to you, please like, comment, subscribe and share on social media that will help other people who need this information find it and get the relief that they need. If you identified with anything we discussed today, please contact us at the office for an immediate appointment. Thanks so much for watching and have a great day. 

Dr. Andrew Schneider
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A podiatrist and foot surgeon in Houston, TX.