Beating Plantar Faciitis
As a Certified Pedorthist over the years, I’ve seen hundreds, if not thousands of cases of plantar fasciitis. For the most part, plantar fasciitis can be overcome with a diligent well-rounded conservative treatment plan, which includes: good footwear, proper support of the medial longitudinal arch, regular stretching, physiotherapy, daily icing, and a night splint.
Unfortunately, research shows that about 10% of cases become chronic, particularly if their daily activities require long hours of standing. Due to the nature of the job, I have found some of the trickiest cases of plantar fasciitis related to the following professions: nurses, teachers, postal carriers, flight attendants.
Since we see so many cases of plantar fasciitis, I’m always interested in learning the newest research in the area. An article in the March 2011 issue of the Journal of Foot and Ankle Surgery caught my eye. It is a paper by Hafner et al. from the Yale-New Haven Hospital.
The study examined 100 specimens of plantar fascia removed from patients with chronic cases on plantar fasciitis (“recalcitrant plantar fasciitis”). The specimens were collected over the course of 14 years – that amount of time commitment to the study really impressed me. This study has two main results:
1. No evidence of inflammation in 54% of the samples
2. Fibromas were seen in 25% of the samples
The fact that more than half of the specimens did not exhibit inflammation is interesting. It is commonly believed that plantar fasciitis is defined as the inflammation of the plantar fascia, thus, the suffix“-itis” of plantar fasciitis. Other studies in the past have also demonstrated this misnomer, and some have suggested that we use the term plantar fasciosis instead of plantar fasciitis.
This study also sheds light on why some individuals have such difficulty with plantar fasciitis. The 25% frequency of fibromas (a benign nodule or neoplasm) with plantar fasciitis is a novel finding – it has never been reported previously. While I have observed soft tissue masses in the plantar fascia through visual and manual investigation, I would have never thought that it would be such a high occurrence.
As a pedorthist, there are ways to make accommodations in orthotics to provide more specific comfort for nodules and fibromas. We can provide cushioning and shape the orthotic accordingly so that the orthoses does not end up providing a high-pressure point. I will endeavour to look more closely at patients for this possibility.
Reference Link: doi:10.1053/j.jfas.2010.12.016