New Treatment Approach to Plantar Fasciitis Holds Promise

New Treatment Approach to Plantar Fasciitis Holds Promise Blog    Plantar fasciitis is a painful and insidious condition that can make life miserable for anyone. For runners and other physically active people, it can be particularly frustrating, keeping you from doing the things you love and interfering with performance and fitness goals.

To date, treatment for plantar fasciitis has mostly centered on orthotic aids pain management and stretching. Yet even with the most aggressive treatment, plantar fasciitis can linger for months or even years.

Now, new research offers hope for a faster, more complete recovery from plantar fasciitis.

Promising New Research

Building on previous research by Wearing et al. (2006), that revealed similarities between plantar fasciitis and other tendinopathies, Rathieff et al. (2017) put Wearings theory to the test by using high-load strength training to treat plantar fasciitis. The treatment approach had proven effective in treating other tendinopathies in the patellar and Achilles tendons.

The study was a controlled trial that used 48 patients with ultrasound-verified plantar fasciitis. Patients were randomly assigned to either a control group who did traditional plantar-specific stretching, or to a group treated with progressive high-load resistance training.

By dorsiflexing the toes on a rolled up towel and performing single-leg calf raises, the research team was able to induce high tensile forces in the plantar fascia similar to those produced in the patellar tendon during a single-leg squat.

All patients were evaluated at three, six and 12 months for pain and foot function. At the three month followup, the high-load group showed a significant reduction in pain compared to the stretching group. At six and 12 months, there was no difference between the two groups.

The authors of the study concluded that high-load training could reduce pain more quickly than traditional stretching. Since pain is the primary complaint in plantar fasciitis, the fastest route to pain relief offers hope for runners and athletes who want to get back to their game or sport in the shortest time possible.

Help for Plantar Fasciitis in NYC

Conventional treatment for plantar fasciitis often involves uncomfortable orthotics, steroid injections and even surgery, yet those methods often fail to resolve the underlying condition. The foot pain specialists at NYDNR understand that foot pain is often related to muscular imbalances and inefficient mechanics in other areas of the body. We use cutting edge technologies and innovative therapies to get to the source of your foot pain and restore optimal function, so you can get back in the game.

Sources

Rathleff, Michael Skovdal, et al. “High‐load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12‐month follow‐up.” Scandinavian journal of medicine & science in sports 25.3 (2015): e292-e300.

Wearing, Scott C., et al. “The pathomechanics of plantar fasciitis.” Sports Medicine 36.7 (2006): 585-611.

 

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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)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

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

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