Truth be told, there really isn’t much going on in plantar fasciitis research, because that’s not where the public’s attention is focused on. Billions of dollars are being spent on various research studies for AIDS, because it’s a fatal disease that cuts across age, racial, and sexual demographics. A lot of money is being poured towards cancer, heart disease, and Alzheimer’s disease research, because a large segment of society is getting older and they’ve become more susceptible to these debilitating ailments.
Plantar fasciitisis not really a medical condition that most people have heard of at all. For the most part, those who are familiar with the condition are the ones who are stricken by it. These include runners, athletes, and workers whose jobs involve a lot of time standing and walking.
But nonetheless, awareness is growing. That’s because as more and more people are working out to combat obesity, more and more people are finding out that there’s a risk to all that jogging and running. Plantar fasciitis is one of those risks, and it’s characterized as heel pain due to tears in the plantar fascia.
What Causes Plantar Fasciitis?
Despite the fact that an estimated 10% of the general population will experience plantar fasciitis at least once in their lives, it is still not known for sure what causes it to occur in the first place. Many plantar fasciitis studies are currently looking into this, in the hopes that the root cause is determined so the condition can be avoided.
Does excess weight really affect plantar fasciitis? Many experts have long realized that being overweight can be a contributing factor to developing the condition. One study conducted by the College of Medicine & Medical Sciences of King Faisal University involving Middle East security personnel noticed that patients with heel pain had a mean body mass index of 30.36, which is already considered as obese. In contrast, the mean BNI of asymptomatic patients was 26.71. This has been confirmed by another study conducted by the Department of Physical Therapy, School of Allied Health Professions, Medical College of Virginia Campus, Virginia Commonwealth University.
What exactly is plantar fasciitis?
It has long been understood that the heel pain is caused by the inflammation of the plantar fascia. But a Temple University School of Podiatric Medicine study showed that some 50 cases of the condition did not exhibit any inflammation of the fascia at all. Instead, other causes were found and the authors of the study advocated a change in the name of the condition to plantar fasciosis.
Then there’s the Hafner study, which suggested that the real causes of plantar heel pain may be more diverse than originally thought. They found that among patients who suffered from recalcitrant plantar fasciitis (the type that goes on for more than 12 months), 25% had plantar fibromatosis, 21% had inflammation, and 54% had no inflammation at all.
It has also been suggested that excessive pronation and supination can cause plantar heel pain. But that may not be entirely accurate, according to a study of foot types among people with or without plantar fasciitis.
Making an Accurate Diagnosis
While it seems fairly easy to assume that plantar fasciitis is the cause of your heel pain, that may not be always true. There can be another cause, such as a fatty cyst or a tear in the ligament. And that’s why another trend in research studies in plantar fasciitis focuses on diagnostic techniques. Currently, there’s a lot of interest on the use of imaging technology to diagnose plantar fasciitis. Here are some points to consider:
- There has been a lot of talk about using ultrasound to examine potential plantar fasciitis patients. It can confirm plantar fasciitis, reveal ligament tears, and find plantar fibroma (benign growth) in the feet. But it has been noted that its reliability increases when clinicians use 3 separate measurements instead of just one.
- MRIs (magnetic resonance imaging) can also help evaluate heel pain, and several studies have been found to confirm its effectiveness.
- Scintigraphy is a diagnostic test used in nuclear medicine, and it can predict how patients will respond to particular treatment methods for plantar fasciitis.
- Elastography is also another diagnostic tool, and it’s a medical imaging method that determines the elasticity of soft tissue. It finds out if the tissue is soft or hard. Researchers are currently studying how it can help with diagnosing plantar fasciitis.
Advances in Non-Surgical Treatments
Most of the time, doctors recommend massages, stretches, proper shoes with arch support art extra cushioning, plus pain reliever medications for plantar fasciitis. But these aren’t always enough, so much so that studies are currently examining other possible ways of treating the medical condition without surgery. Surgery is always the last option, when all nonsurgical methods have brought no significant improvements.
- A study published in the International Journal of Radiation Oncology noted that radiation therapy can help with the pain caused by the fascia injury. Since it is characterized as an inflammation of the plantar fascia, it was hypothesized that radiation therapy may have some beneficial effect as it has been used for its anti-inflammatory effect for more than 60 years.
The study showed that, upon receiving a standard dose similar to what cancer patients get, 80% of the patients experienced complete pain relief. This is in stark contrast to the short term relief experienced by those who received the standard heel pain relief treatments for plantar fasciitis. After 48 weeks, the pain relief was constant or even improved in 64% of the patients who received the radiation treatment.
- Others have also underwent extracorporeal, although the initial results were far from conclusive. This nonsurgical method involves the use of pressure waves to treat musculoskeletal problems. It delivers shock waves (high-energy acoustic waves) that deliver a mechanical force on the tissues.
In a way, this is simply a high-tech version of a massage, except the pressure on the tissue is delivered directly and more deeply. The procedure when using high-energy waves requires the use of local anesthesia, as it can be painful. Afterwards, the patient can bear more weight on the affected foot, but some reduction of physical activity may be needed for a week or two.
However, initial studies show that only 37% of patients improved with ESWT treatments, while 24% the control group that received the sham treatment improved as well.
Later studies did demonstrate an improvement for 95% of the patients in another study. In addition, the use of low energy shock waves didn’t do much good, with stretching exercises providing better results.
With such disparate results, more definitive studies are still required to gauge the true effectiveness of this method.
- There have also been some attempts to use platelet-rich plasma (PRP). Several notable athletes have received this treatment for various injuries, including golf sensation Tiger Woods and tennis superstar Rafael Nadal. News reports have also mentioned that Kobe Bryant and Alex Rodriguez have also received PRP treatment.
Blood in liquid form is called plasma, and it also contains platelets. These platelets are known for their ability to clot blood. But they also contain hundreds of proteins called growth factors, which are crucial for healing injuries. PRP is blood, except that it contains more platelets than usual.
When used specifically for plantar fasciitis, it was found in a study of 25 patients that 80% were completely satisfied with the reduction of the pain they felt. About 60% of the patients did not have any functional limitations after the PRP injection, and another 32% felt minimal functional limitations. The authors of the study concluded that PRP is both safe and effective, although more studies are needed involving more patients.
- Steroid injections have also been tried out. The initial results were encouraging, as a study involving 65 patients with heel pain showed that there was significant alleviation of the pain for up to 12 weeks.
- Another study also indicated that custom-made orthotics (foot pads or inserts) were more effective when combined with the use of rocker sole shoes. In tandem, these devices helped minimize the pain in the heel, compared to just using one of the devices alone.
It’s pretty much evident that there is still no definitive conclusion on many issues concerning plantar fasciitis. This is a troubling realization, as at least a million people suffer the condition once a year and the injury can last an average of 5 months.
Yet it is encouraging to note that studies are still being conducted on the subject. Part of this increased interest is because it is affecting the careers of many notable professional athletes. Also, more and more people are suffering from the condition, as workouts have become more common among people desperate to lose weight because of the obesity epidemic.
For the moment, patients with the condition will still have to rely on tried and tested relief recommendations for plantar fasciitis. The new methods are too new, which means they can be expensive and their true effectiveness is not yet known. But in the future — who knows?