Plantar Fasciitis: New Treatment Possibilities

plantar fasciitis heel pain

Heel pain is a common physical complaint affecting about 10 percent of Americans. The pain may be mild or severe, making it difficult to perform the normal activities of daily life. While there can be several different sources of heel pain, the most common is a condition called plantar fasciitis.

What is plantar fasciitis?

The plantar fascia is a to the bones of the foot. It helps coordinate the motions of the foot and ankle, and may also work as a shock absorber for the body.

In plantar fasciitis, the fascia becomes swollen or irritated through injury or overuse, making it painful toms are usually worst immediately upon arising in the morning and usually subside after activities that stretch it.

People describe the pain as sharp and stabbing, and they typically indicate that the pain is on the underside of the heel or in the arch of the foot. Walking – especially the first few steps after a lengthy period of inactivity or sleep – makes the pain worse.


Plantar fasciitis is not a simple problem; there may be many contributing factors.

    • Injury

An abrupt, traumatic injury may damage the fascia causing swelling and pain.

    • Activity level

Long-distance runners are at greater risk since their feet repeatedly strike the ground with increased force, creating multiple small tears in the fascia. Another high-risk group is people with a sedentary lifestyle. Especially vulnerable are the “Weekend Warriors” who suddenly increase their level of physical activity after days or weeks of rest and inactivity.

    • Mechanics of movement

If posture is poor or if feet and legs are not optimally positioned during activities like walking or running, it can also damage the fascia. For example, the feet may roll slightly inward (pronation) or outward (supination), putting unusual stresses on one side of the band. Similarly, the knees or hips may be misaligned during movement. Gait aberrations can have a major impact on the health of the underlying physical structures of the body, including the plantar fascia.

    • Foot structure

Have flat feet, or conversely, having high arches may predispose the foot to injury.

    • Occupation

Jobs that require standing for long periods of time on hard surfaces can create excess stresses on the underside of the feet. One example of this type of occupation would be classroom teachers.

    • Age and weight

Age and obesity and both correlated with heel pain and plantar fasciitis. This makes sense because the connective tissue may lose its flexibility over time, and heavier weight compresses the fascia, which may damage it.

    • Nutritional considerations

Of course, vitamins and minerals can also play a role. Shortages of iron, magnesium, calcium, or B vitamins may affect the health of the connective tissue.

    • Stress

One of the hallmarks of stress is muscle tension. When muscles are tense, they contract, becoming shorter and tighter. This contraction worsens plantar fasciitis.

    • Other factors

Many other parameters may affect heel pain, for example, arthritis, circulatory problems, and endocrine disorders such as diabetes, which may damage the nerves.

Traditional therapy

Plantar fasciitis may be a chronic issue, and recommended treatment regimen varies by practitioner. Unfortunately, effectiveness is sporadic, and success is often only temporary. Some of the more common treatment modalities include: stretching exercises or devices, orthotics or other adjustments to footwear, steroid injections, acupuncture, acupressure or massage.

Therapy has traditionally been focused on the exact site of the heel pain. However, new approaches are beginning to the heel.

Myofascial trigger points

It may be useful to form a single continuous system. Pulling the string in one location affects the entire system.

Movement is a coordinated series of actions involving the whole body, which is why an aberrant gait can create pain in multiple locations. Instead of assuming that heel pain originates only in the heel, it makes sense to consider that there could be irritable spots anywhere along the integrated system. These hypersensitive spots in the skeletal muscle, called myofascial trigger points, may create dysfunction anywhere along the leg but may ultimately be experienced as heel pain.

New approaches to therapy

Practitioners are beginningto treat plantar fasciitis. The results have been exciting. Case studies using both acupuncture and ischemic compression therapy suggest that treating trigger points along the muscle lines may have profound effects upon plantar fasciitis pain. In some cases, patients have reported immediate pain relief as well as a feeling of lightness.

Because plantar fasciitis is a complicated problem with many contributing factors, therapists cannot use a single-focus solution. Applying treatment along the entire line of integrated muscles and connective fibers holds great promise.


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)


Complete tear of rectus femoris
with large hematoma (blood)


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

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