Chronic plantar fasciitis
Choosing a treatment for chronic plantar fasciitis is difficult, as there are dozens of treatment options with no clear standard of excellence. Unfortunately, the effectiveness of continued conservative treatment for lower heel pain decreases if symptoms do not go away after 3 to 6 months of standard treatment. In these cases, patients should consider more advanced options to achieve satisfactory symptom relief. The lack of evidence for new therapies further complicates treatment decisions.
So, besides conservative treatments, what are the possible treatments for chronic plantar fasciitis? Here is a brief description of each.
N.B: IN A COMPLETE TREATMENT PLAN CAREFULLY CARRIED OUT AND QUICKLY IMPLEMENTED, THE COMBINATION OF CONSERVATIVE TREATMENTS REMAINS THE BEST TREATMENT.
Extracorporeal shock wave therapy
Extracorporeal shock wave therapy is a minimally invasive treatment for recalcitrant plantar fasciitis. The targeted application of shock waves to injured soft tissue disrupts scar tissue and induces revascularization, releases local growth factors and recruits stem cells to enhance intrinsic healing.
During a 6 to 12-month follow-up, extracorporeal shock wave therapy produces greater improvements than conservative care in patients with chronic plantar fasciitis. However, in the long term, extracorporeal shock wave therapy is not more effective than specific stretching of the plantar fascia.
The radiofrequency microanatomy technique has been applied to chronic tendinopathies for over a decade with promising results. Radiofrequency microanatomy stimulates angiogenesis in the avascular fibrotic fascia, which promotes the secretion of fibroblast growth factor, vascular endothelial growth factor, and vascular cells. Histological evaluation of the treated tendons shows an early inflammatory response, with a significant proliferation of vascular cells and the formation of new blood vessels within 28 days.
Platelet Rich Plasma (PRP) Injections
PRP is an autologous blood-derived biologic that contains high concentrations of growth factors derived from platelets. Soft tissue healing is believed to be stimulated by increased fibroblast migration and proliferation, upregulated vascularization, and increased collagen deposition. Very promising treatment and which, again, does not have all the scientific research to further promote this treatment option.
Cortisone is a hormone produced by the adrenal glands in your body in response to stress, allergic reactions, and inflammation. Cortisone injections use a synthetic version of naturally occurring cortisone (also called a corticosteroid) to fight inflammation in very specific parts of the body, such as the heels. They are usually injected where the pain is most severe.
Even though plantar fasciitis has been described above as non-inflammatory and chronic, a cortisone injection is still the most effective treatment today in cases of plantar fasciitis refractory to conservative therapy.
Although most cases of plantar fasciitis can be effectively resolved with inexpensive at-home treatment options like stretching, rest, and ice putting, a unique treatment plan cannot be applied to every person. The key is to treat the acute phase before it becomes chronic, which makes other treatment options more realistic. So, for patients with plantar fasciitis, the most effective treatment is to address the pain and the cause as quickly as possible.
The sooner a comprehensive treatment plan is put in place, the greater the chances of recovery!