4 Popular Treatments for Plantar Fasciitis Heel Pain — Which is best?

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Plantar fasciitis is a painful and debilitating overuse injury that affects a broad range of people, including athletes, runners and anyone who stands on their feet for prolonged periods of time. The plantar fascia is a thick band of connective tissue that spans the bottom of your foot, from your heel to your toes, acting like a rubber band to propel you upward during the gait cycle.

Plantar fasciitis pain is caused by repetitive microtears of the fascia tissue near the heel that lead to collagen degeneration. In some cases, there is an ossification (hardening) of soft tissues at the heel, creating a heel spur. With rest and attentive care, plantar fasciitis normally resolves itself over time, but the condition can be persistent, lasting for months or even years.

Plantar Fasciitis Treatments

Many approaches have been taken to ease the pain and accelerate the healing of plantar fasciitis, with varying results. Some of the most common treatments include:

  • plantar fascia and calf muscle stretching
  • eccentric loading exercises
  • nonsteroidal antiinflammatory drugs (NSAIDs)
  • corticosteroid (CS) injections
  • physio taping
  • shock absorbing heel cups
  • orthotic arch supports
  • night splints
  • electrotherapy
  • lidocaine needling
  • Prolotherapy (proliferation therapy)
  • blood injections
  • platelet rich plasma (PRP) injections
  • extracorporeal shock wave therapy (ESWT)

4 Progressive Plantar Fasciitis Treatment Approaches

Four of the most progressive treatment methods for plantar fascia pain include Prolotherapy, PRP injections, corticosteroid injections and ESWT.

Prolotherapy involves injection of an irritant (essentially sugar water) into the painful tissues to evoke an inflammatory response. Inflammation brings an influx of oxygen and nutrients to the injured site, which in turn promotes healing of the damaged tissues.

PRP, or platelet rich plasma, injects the patient’s own blood plasma into the injured tissues, with the goal of infusing high concentrations of platelet-derived growth factors to initiate healing.

Corticosteroid injections reduce inflammation of surrounding soft tissues, which helps to reduce pain, but does not necessarily promote healing.

ESWT is a non-invasive treatment that uses single-pulse sound waves to stimulate healing and generate new tissue growth.

A Study Comparing the 4 Treatments

In a recent study, Urgular et al. (2018) compared the effectiveness of the four treatment approaches to see which performed best. Study participants included 158 patients who suffered from plantar fasciitis for 12 months or longer, and who also had a heel spur. The patients were randomly assigned to one of four groups, and each group was treated with one of the four methods. A follow-up was conducted 36 months later to see if the treatment had long-term effects.

Here are the study’s findings:

  • Corticosteroid injections were effective in treating pain during the first 3 months after treatment, but the effects diminished over time.
  • Prolotherapy and PRP were both effective between 3 and 12 months after treatment.
  • ESWT was effective in relieving pain and promoting healing over the first 6 months.
  • At the 36-month followup, no difference could be found among the 4 treatments.

So which treatment is best?

The bottom line is that shockwave therapy is safe and non-invasive. It is faster, much less painful and has zero side effects compared to PRP, Prolotherapy and steroid injections. More importantly, from the patient’s perspective, ESWT is the least expensive of the four treatments, making it a winner in our eyes.

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Treatment for Plantar Fasciitis Pain in NYC

If you live or work in NYC, the NYDNRehab clinic is conveniently located in midtown Manhattan. Our clinic features some of the latest technologies and most innovative therapies rarely found in most rehab clinics. The team at NYDNR treats every patient as an individual, never taking a one-size-fits-all approach to treatment. Contact NYDNR today, and take your first steps toward plantar fasciitis relief.

130 West 42 Street Suite 1055, New York NY 10036
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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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