Plantar fasciitis: throw the kitchen sink at it

Personal opinion on plantar fasciitis

I normally write these personal opinions at the bottom of the articles, but for plantar fasciitis I think its so important I am writing it at the start of the article. There are so many different treatments for plantar fasciitis and every one of them has their champions and they also have their detractors. Can you see how that is a problem? Go to YouTube and you find plenty of videos on the “truth” about plantar fasciitis. However, each one has a different truth. How can any one of them be the truth, if their truths are different? Can you see how that is a problem? Go to Amazon and there are plenty of books you can buy which the have “secret” for curing plantar fasciitis. However, each one has a different secret. Can you see how that is a problem? Everywhere you go online, you see testimonials and anecdotes for X treatment being the cure for plantar fasciitis. However, you can also see anecdotes that X does not work. Can you see how that is a problem? On social media you can come across advertisements and advocates of the one single treatment that will cure everyone with plantar fasciitis; ie the one treatment to fix all. Can you see how that is a problem? There are websites that collect information from patients with a wide range of medical conditions as to what treatment worked for them for that condition. If you look up plantar fasciitis on these websites, you will see votes for almost every imaginable treatment! Can you see how that is a problem? There are no shortage of “gurus” advocating the one best treatment for all. However, each guru is recommending something different as the one best treatment for plantar fasciitis. Can you see how that is a problem?

If you have plantar fasciitis or a clinician treating it, what are you supposed to do with all this information? The problem is if you try something and it does not work, you then try the next suggestion and that might not work, so you try the next suggestion and that may not work, and so on and before you know it you then have a condition that has become chronic that is even harder to manage. If there was ever a condition that really does need the kitchen sink to be thrown at it as early as possible, then it would probably be plantar fasciitis.

The problem with anecdotes and testimonials about a cure or treatment we have no way of knowing if it really worked or not. If someone claims that X fixed them, then how do they know that it really was X or not or something else? Obviously they are convinced that X did fix them and there is nothing I say is going to convince them otherwise. It may have been X that fixed them, but it could easily have not been X. They could have got better not because of X, but despite X and it was just a placebo as to why they got better. X may not have been the reason, it could have been something they used or did a week or a month or so beforehand that is the reason they are better. It just took a while for it to help. It could have been just the natural history and the plantar fasciitis was just about to get better on its own (and yes it can do that) and the “cure” was nothing to do with X, but they are adamant that it was. It could be that at the same time as they used X, they also did Y and Z. They may have got better because of Y and/or Z and it had nothing to do with X, but they tout X as it was the most noticeable thing that they did. Can you see the problem with all this and how skeptical of any recommendations that you might get from people who may have had plantar fasciitis you have to be?

So what should you as someone with plantar fasciitis or a clinician treating it with this overwhelming amount of information. How to distil it down into something practical and useful. Research using clinical trials is the way out of this. If you were to take 100 people with plantar fasciitis and do nothing, then after a month or so x% will be better. If you took 100 people with plantar fasciitis and treated them with something that is absolutely useless, then that same x% are still going to be better. Those in the x% group who got better are going to be totally convinced that it was that absolutely useless treatment that fixed them. In social media, they will become champions for that useless treatment. Can you see how that is a problem? What is needed is two groups of 100 people with plantar fasciitis. One group is given what ever treatment is being tested and the other group is given nothing or a placebo. After a month or so x% in each group will have improved because of the natural history, even in the placebo group. However, if the treatment used is any good, then there will be more than x% in the group that get better. Researchers then use statistical tests to see if that more than x% is significant or not. This is the simplified version of how clinical trails are done to see if any treatment is better than what would happen naturally or if a placebo was used. The trial may test a treatment against doing nothing or a placebo or the clinical trial may test a couple (or more) different treatments to see which one is better, knowing that some will always get better by doing nothing (or taking a placebo). Can you see how much better information from these sources is better than the anecdote or testimonial? Disclaimer: there are ways of evaluating clinical trials to make sure they stack up to analysis and a lot don’t, especially in plantar fasciitis research. There may be problems with the nature and characteristics of the control or placebo group; there may be differences in the groups on some characteristics (eg one group may be older); the randomization to groups may be not done properly; the wrong statistical analysis maybe done (an eg for the nerds: it is not uncommon to report the results using a within groups analysis rather than a between groups analysis); etc

One problem with the clinical trial is that even though they might show a treatment is better than a placebo. This is only “in general” or for most people in the trial. There would have been some in any clinical trial for which the treatment did not work (or even made it worse), even though it worked for most. In clinical practice the same can happen. While we know that, generally a particular treatment works for plantar fasciitis from a clinical trail, there will be some in clinical practice in which it does not work for. They will then advocate against a treatment that is potentially helpful for most. How many people then do not pursue a potentially helpfully treatment because of that advocacy based on that anecdote?

Anecdotes are powerful drivers of ones beliefs, but can also bias people in pursing or not pursing a potentially useful or useless treatment, so they need to be treated with suspicious and data from clinical trials when available and that stacks up to scrutiny relied upon to eliminate those biases and make decisions. Hopefully you can see why I wanted to talk about my personal opinion here at the beginning rather than what I normally do at the end.

What is Plantar fasciitis

Plantar fasciitis is by far the most common cause for pain under the heel. The plantar fascia (or plantar aponeurosis) is a strong and long ligament under the arch of the foot that goes from the bottom of the heel to the ball of the foot and base of the toes. Its main function is to, basically, support the arch of the foot via a system called the windlass mechanism.

There are a number of terms used around this that do have more specific meanings and definitions, however, then tend to be used interchangeably. ‘Plantar heel pain‘ is probably a better term. It should not be called a plantar heel spur (see below as to why). I still do call it ‘plantar fasciitis’ here as that is still the most widely used and searched for term on Google. Plantar fasciitis also implies that it is an inflammation (“-itis”) and while most cases probably do have some element of inflammation in them, especially early in the condition, the most prominent pathophysiological process is probably degeneration so the term ‘plantar fasciosis’ is sometimes used. Some like to make quite a fuss over the ‘-itis’ vs ‘-osis’ distinction. This is not really the place for academic debates over what to call it. When I say ‘plantar fasciitis’, you know what I mean.

Causes of Plantar Fasciitis

There is only one causal pathway in plantar fasciitis: that is the cumulative loads on the plantar fascia exceed what the plantar fascia can take. Because of that, the plantar fascia ‘breaks down’ and becomes inflamed initially and later begins to show signs of degeneration. Plantar fasciitis is more than likely not due to one cause, but the mix of risk factors that increase the chance of that causal pathway. There are two parts to this causal pathway: the loads on the plantar fascia and the vulnerability of the plantar fascia:

Cumulative loads on the plantar fascia:
The basic and simplified function of the plantar fascia is to support the arch of the foot (its does have some other somewhat more complicated functions, but will leave that for another time and place). Anything that increases loads on the arch of the foot is going to increase the loads on the plantar fascia:

1. Obesity. Obesity is a well documented risk factor for plantar fasciitis. Being overweight puts increased loads on the plantar fascia. This makes a lot of sense. Also a factor here may also be carry heavy loads like backpacks. BMI is a significant risk factor for plantar fasciitis.
2. Tight calf muscles: Tight calf muscles are also a well documented risk factor for plantar fasciitis. If that muscle/tendon complex is tight and limits movement at the ankle joint, then the midfoot moves more to compensate. This collapse of the midfoot puts more strain on the plantar fascia. Also , there are fibrous connections between the Achilles tendon that run down the back of the heel bone to under the foot and the plantar fascia. This connection may also play a role.
3. Biomechanical issues: Any functional or structural issue with the foot that puts pressure on the arch of the foot will increase the risk for plantar fasciitis. This includes the tight calf muscles mentioned above; a structural alignment issue such as for eg, forefoot varus; a functional issue such as, for eg, a high force is needed to establish the windlass mechanism; it could be the running technique used, with an eg of forefoot striking placing greater loads on the plantar fascia; it could be weaker intrinsic muscles in the arch of the foot (if these muscles are stronger they can take some of the load off the plantar fascia).
4. Volume of activity: If the repetitive loads on the arch of the foot are high, then the repetitive strains and loads on the plantar fascia are going to be high. The volumes of activity such as running marathons or standing all day at work, especially on hard concrete floors are all going to increase the risk of plantar fasciitis.

Vulnerability of the plantar fascia:
This is how susceptible or prone the plantar fascia is to damage. A number of variables can make the plantar fascia less resilient to the loads that are applied:

1. Adaption: The human body is quite remarkable and structures like the plantar fascia can adapt to taking the quite large loads that are placed on it. However, the tissues in the body need time to adapt to the loads. If the cumulative loads put on the plantar fascia are increased too rapidly and not given time to adapt, then that increases the risk for plantar fasciitis. This is the good old fashioned saying of ‘too much, too soon. This could be a too rapid increase in the distances that a runner runs or it could be a sudden change in work routines (eg going from a sitting to a standing work environment) or it could mean sanding all day at, for eg, a music festival when you are not used to being on your feet all day. The plantar fascia can adapt to these types of higher loads provided that it is given time to do so and increases are done gradually and slowly over time. As we get older, the plantar fascia finds itself harder to adapt to loads, so are more prone to plantar fasciitis.
2. Tissue quality: There are a number of medical conditions that make the tissues more prone to damage. For example, the glycation of the proteins that occurs in diabetes mellitus affects the collagen, impacting elasticity of the plantar fascia and will make it more prone to damage.
3. Nutritional status: Deficiencies in some dietary elements may may a role in making the tissues more vulnerable. For example a lack of Vitamin D is associated with a number of foot and ankle problems. A few years ago, magnesium supplements were all the rage on social media as ‘the cure’ for plantar fasciitis with an extraordinary number of anecdotes supporting it. Some of the amino acids play an important role in tissue status and healing.

Other issues that may play a role in the cause of plantar fasciitis:
While not a cause, there are psychological variables that impact the perception of the pain that plantar fasciitis creates and plays an important role. There are also chronic pain conditions like fibromyalgia that do not necessarily cause heel pain, but because of the chronic pain issues a relatively mild or minor heel pain condition can be perceived as being extremely painful.

Symptoms of Plantar Fasciitis

Before you start to treat plantar fasciitis, you need to get the diagnosis right. The classic symptom is a sharp, deep stabbing pain under the heel that is worse when you first put the foot on the ground after rest. This classic symptom of plantar fasciitis is called post static dyskinesia or first step pain. There are several theories to explain what causes that post static dyskinesia. After several steps the pain does ease somewhat, but is still painful. Whilst this plantar fasciitis is by far the most common cause of this symptom, there are some other conditions that can also cause it. Almost all cases of plantar fasciitis have this symptom, however if there is pain under the heel that does not have this classic first step pain, then that should be a flag to look for other reasons for the heel pain. The absence of this first step does not rule out plantar fasciitis, it just means that it is less likely to be plantar fasciitis.

There are a number of conditions to consider when someone is being assessed for a possible plantar fasciitis. These include gout; Baxters neuritis; calcaneal stress fracture, Severs disease (only in kids), policeman’s heel (plantar bursitis); seronegative spondyloarthropathies, myofascial pain syndrome, tension myositis syndrome, fat pad atrophy, tarsal tunnel syndrome, oseteoarthritis of the talocalcaneal joint.

Imaging may be needed to confirm the diagnosis. X-ray do not show plantar fasciitis, but can be used to rule out other causes. Diagnostic ultrasound can be used to measure the thickness of the plantar fascia and that can be used to determine if its inflamed. The ‘darkness’ on the ultrasound image (hypoechogenicity) can see the amount of degeneration.

It is important that you get the diagnosis right before starting treatment. I see too many asking for advice online and head off treating the wrong thing (ie they do not have plantar fasciitis). There are a number of plantar fasciitis support groups on places like Facebook. I periodically dive in for a look, but never stay for long as its too frustrating. Everyone in these groups has their favorite cure that they tout (see the personal opinion above). Of most concern is people describing their symptoms and asking for advice. Some are quite clearly not a plantar fasciitis based on the description they give. They then head off and treat themselves based on the advice they were given. I would/could face legal and ethical issues giving such advice. Please get the diagnosis right first.

Treatment of Plantar Fasciitis

The approach to managing plantar fasciitis is to deal with the symptoms, reduce the loads increasing the risk for the problem and increase the resilience of the plantar fascia by reducing its vulnerability to damage. There are a number of strategies that can be used on top of that to facilitate healing if needed and if all that fails, there are surgical options as a last resort:

Manage the symptoms:
Depending on how much pain people are experiencing, strategies to reduce that pain and mask the symptoms can be used to make it more comfortable. There is nothing wrong with masking the symptoms in the short term. There are a number of strategies that can be used for symptomatic relief:

1. Ice can be used to help with pain relief, particularly if somewhat acute. The research is now indicating that ice to reduce the inflammation is probably of not much use, however that does not mean it should not be used to help with the symptoms in the short term.
2. Medications can be used to help, for example, NSAIDs (eg ibuprofen). They are not going to do a lot if just used on their own and nothing else is done.
3. Manipulation and mobilization can potentially help with pain as one of the supposed mechanisms of manipulation is neuromodulation which can change the sensation of pain. It can also help with the ankle joint range of motion (see below). and reduce any other restrictions in ranges of motion of joints.
4. Self massage and the use of foam rollers can help ease the symptoms. The use of rolling the foot over a tennis ball has been advocated for a very long time. I used to suggest the use of the old Coca Cola glass bottles that used to have a convex and concave surface. Sadly, you can’t get them any more. There are specific commercially available foot roller products such as the Pediroller that can be used to roll the foot over.
5. There is a subgroup of those with plantar fasciitis that tend to have more pain when the foot first hits the ground when walking on a hard surface and another group that tend to have more pain under the heel when pushing off the ground. The group that have more pain at heel contact tend to get some relief with shock absorbing heel pads.
6. Some combine the self massage with the use of rubbing in creams such as for eg Deep Heat, fisiocrem, Voltaren.
7. Hot packs, often containing things like wheat, that can be heated in a microwave are often useful for some relief from most chronic pain issues. For plantar fasciitis, you simply place it on the ground and rest the foot on top of it. The combination of hot packs, self massage with a roller and rubbing in a cream can often give some relief for most people.
8. Trigger points (or ‘knots’ in the tissues, especially the muscles) can complicate plantar fasciitis and can be address with kneading of the trigger points or the use of dry dry needling. There is a bit of controversy in the research on this, but it does appear to help with the relief of symptoms.
9. Photobiomodulation or low level laser therapy is showing promise at helping to reduce the symptoms of plantar fasciitis.
10. In those cases of plantar fasciitis that are really bad and the tissues are very sensitized, may need to be put into a moon boot or CAM walker for anywhere from a few weeks to 6 weeks to let the tissues settle down. Once settled down a lot, they will probably be more responsive to things like foot orthotics and other treatments.
11. As with all pain problems the importance of adequate sleep and psychological well being can not be understated in helping improve symptoms. Please make sure they are addressed.

None of the above reduce the load on the plantar fascia or increase the resilience of the plantar fascia, so should be looked on as short term measures to help with the pain and make it more comfortable. Sometimes if the pain is decreased with them and activities levels are slowly increased, then this can help the plantar fascia take more loads over the medium and long terms (see below). In the more minor cases of plantar fasciitis, this may be all that is needed.

Reduce loads on the plantar fascia:
Reducing the loads are probably going to be highly effective as reducing the symptoms from plantar fasciitis and allow healing to take place. Once this healing has begun to take place, then loads can be gradually and slowly increased if needed allowing the tendon like tissues to adapt to those loads. The various strategies for this include:

1. Rest or activity modification. The best way to reduce loads on the plantar fascia is to simply get off the feet and rest more. If you have a job that involves a lot of standing, then can some of it be done sitting? If you are a runner, cut back a bit and perhaps substitute some runs with cycling or swimming. Mostly use your common sense. The amount and level of activity can be increased later (see below).
2. Strapping or tape is a very effective way of reducing the load in the plantar fascia in the very short term. It can be used to allow athletes to keep participating in sport and allow people with jobs that involve a lot of standing to keep working. A common method is what is called Low-dye strapping. It is important that the tape be applied correctly to reduce the load in the plantar fascia. If its not applied correctly, then its not going to help. This is one of the most effective short term methods of load reduction, but is not very practical over the medium or long term.
3. Research has shown that a simple heel raise can reduce the loads in the plantar fascia, perhaps with there being less pull from the Achilles tendon. This could be 1cm lift inside the shoe, or a shoe with a 1-2cm heel height. For a running shoe, look for one with a 10-12mm drop. This can be a useful short to medium term measure used with other approaches. It does not need to be used long term.
4. Foot orthotics are a very effective way at reducing the load in the plantar fascia. They are not simply a matter of supporting the arch, but they need to have design features in them that have an effect of reducing that load – this includes inverting the heel, elevating the lateral column and having a groove in them if the plantar fascia is prominent. It probably does not matter if they are purchased over-the-counter, are pre-made or custom made as long as they have the design features for each foot to achieve what is needed – getting this right is important as if its not right, then they will not help. They can work well in the short to medium term and can be used in the long term if needed (not every one needs them long term). Despite the rhetoric and propaganda in social media, they do not weaken muscles – the preponderance of the evidence is pretty clear on that.
5. If you are overweight, then loosing weight is probably the most beneficial thing that you can do for plantar fasciitis and your general well being. A high BMI is a significant risk factor for plantar fasciitis, so a reduction can reduce a lot of load in the plantar fascia. This is going to be a long term approach as results do not come quickly, so other strategies are going to have to be used in the short and medium term.
6. As tight calf muscles contribute a lot to the load in the plantar fascia, then calf stretches are very important to help reduce this. This is not going to help much in the short term as it takes a while for the muscle/tendon complex to lengthen in response to stretching so is more of a medium term strategy, as long as you remember to do it at least daily. There are night splints that can be worn to help stretch the calf muscles more while sleeping and help reduce that first step pain in the morning. There are various contraptions and devices that can be purchased commercially to help with the stretching here. There is nothing special or magical about them, but they are probably a bit more convenient to use to help you stretch the calf muscles rather than just the lean against the wall stretch. Quite often the ankle joint range of motion is restricted because of the mobility of the fibula bone and this is where ankle manipulations can be quite effective in the short term, if this is the cause of the limited motion at the ankle joint.
7. Another way to reduce load is to strengthen the small intrinsic muscles in the foot as if they are stronger they can take some of the load that would be taken by the plantar fascia. This is likely to be more effective if they are weaker. This is more of a longer term strategy as the strengthening exercises will take a while to make the muscles noticeably stronger and have an effect, so other short and medium term approaches are going to be needed of you want to rely on this. You also have to remember to do the exercises at least daily. The evidence is also clear that the intrinsic muscles are weaker in those with plantar fasciitis which is probably more likely due to a disuse atrophy because of the the pain rather than the cause. This does, however, mean that strengthening is an important part of the rehabilitation. There are exercises such as the toe curl exercise and the short foot exercise that can be used. There are also commercially available contraptions or devices that can be used to facilitate the strengthening exercises..

Its not a matter of picking one and seeing how it goes. The kitchen sink approach should be used and as many of the above that can be done, should be done at the same time.

Reduce vulnerability of the plantar fascia (increase its resilience):
If the plantar fascia is a strong and resilient tissue, then the biomechanical factors that increase the loads may not necessarily be a problem. The strategies here include:

1. The health of the tissues is important. You need to make sure that your diet is meeting all the nutritional needs that are required. Any potential deficiencies should be addressed in case they are part of the problem make the plantar fascia more vulnerable to damage. Take some supplement of you need to.
2. Adapting to the loads. The aim here is to improve the ability of the plantar fascia to take loads by allowing it to adapt to them. There are two concepts that underpin this strategy. Firstly it means that the loads placed on the plantar fascia have to be gradually and slowly increased with adequate rest periods to allow it to adapt. This has to be done within the tolerance of pain as the symptoms of the plantar fasciitis reduce. The increases in load via activity levels need to be small and then back off to allow the tissue to recover and become stronger before another small load is applied. This needs to be carefully managed and is possibly the most important part of the rehabilitation. Going too quickly is going to lead to a setback and prolong the problem. The second concept is a specific loading program for the plantar fascia that consists of repeated heel raises with the toes elevated. This applies a load to the plantar fascia to help it adapt to increasing loads and making it stronger. The loading programs advocated to do this do appear to be somewhat effective, but the evidence is over hyped in some places and a recent review did not consider the evidence string enough to recommend it. This specific plantar fascia loading program will also have the advantage of helping to strengthen the small intrinsic muscles (see load reduction above).

Facilitate the healing:
It is important that load reductions and reducing the vulnerability are done first otherwise there is going to be a high probability that attempts to facilitate healing get undone without those approaches. There are a number of strategies that on there own may not be sufficient, but in conjunction with the above can be good at settling the problem and getting healing under way. Strategies here include:

1. Shockwave therapy is one way to give healing a “kick” along and to stimulate the healing when its not progressing as well as expected with the load reduction and vulnerability approaches.
2. Cortisone injections have been shown to be effective in the short term, but there appears to be diminishing returns with repeated injections. They are a powerful way to deal with any inflammation in the tissues and may also help significantly with managing the symptoms (see above).
3. Platelet rich plasma may or may not help. The research results are somewhat mixed with this and it may be over hyped. If it helps, it just injects into the area that is damaged some plasma that has the elements the tissues need to heal.

Please if you do undertake any of the above unless you also reduce the loads (see above) and increase the resilience of the plantar fascia (see above) or any good done by the facilitate healing approaches runs the risk of being undone as soon as you put the foot back on the ground. If the risk factors that caused it in the first place are still present and not dealt with then an eventual recurrence is possible.

Surgery:
When all else fails, then there is always the knife. Surgery is indicated when its needed. Hopefully not to often. The most common procedure is an endoscopic partial plantar fasciotomy in which a partial cut is made in the plantar fascia.

“Best shoes” for plantar fasciitis

If you Google that, there is no shortage of advice and lists for thing like the “Ten best shoes for plantar fasciitis”. Each of those lists has a different collection of shoes and every one of those lists list shoes that have an affiliate link for the publisher of the list to earn some money on purchases made of the shoes. Hardly a useful list when there is money involved and hardly a useful list if every list of the “ten best” are ten different shoes to the other!

There is no shortage of advice on X shoe being the best shoe for plantar fasciitis. For every person saying X shoe fixed their particular plantar fasciitis there is another saying that the same shoe caused their plantar fasciitis. If you have plantar fasciitis, what advice should you follow? If you are a clinician, what shoes should you advise in the face of such conflicting claims?

The particular type of shoe may not even be to blame. For example a runner may get a new pair of running shoes and in the excitement go for a few longer runs than they are probably ready for and then get plantar fasciitis. They will blame the shoe and become an advocate against that particular brand of shoe as they believed it caused their plantar fasciitis, when the actual cause was the excessive running that they were not adapted to running. I have had runners tell me to stay away from Hoka running shoes as they are the worst for plantar fasciitis. I have had other runners tell me that getting into Hoka’s was what cured their plantar fasciitis. Same for the Crocs and most other shoes. I guess it depends on whose advice you get exposed to or read, but if you have been around for long enough you have head it all.

So what shoes should you wear if you have plantar fasciitis and want advice? There is no evidence that any one shoe is better or worse than another. The studies have just not been done.

I suspect that if you get plantar fasciitis wearing a particular shoe, then changing to a different type of shoe might help. It may not matter what type, what might matter is a change. That change might just lead to different loads in different tissues and may help ease the load on the plantar fascia (see ‘reduce loads’ above). This hypothesis might help explain why so many shoes get blamed for plantar fasciitis and that same set of shoes can also help – its the change that matters and not necessarily the type of shoe that is important.

Having said that, a shoe that is 1-2cm higher in the heel might be more helpful as this will reduce the load from the Achilles tendon stretching the plantar fascia. There is evidence to support a heel raise reducing loads in the plantar fascia, so runners probably should avoid zero drop shoes – this can be short term measure to reduce loads, that can be reduced back in the medium to long term. (And of course, there are claims and anecdotes that minimalist zero drop running shoes both cure and cause plantar fasciitis!). Many find that footwear with arch support (eg the Archies flip-flops) can provide some help, at least in the short to medium term.

What about heel spurs or bone spurs and plantar fasciitis?

You often see heel or bony spurs mentioned along with plantar fasciitis as being a problem. However, they are more likely probably just an irrelevant incidental finding. 20% of the population have them and don’t have problems.

It used to be considered that the spur that develops under the heel is from traction of the plantar fascia and is part of the syndrome around plantar fasciitis and plantar heel pain, but we now know that they are not even in the plantar fascia! You still read and see a lot about this, so most of it is probably best ignored.

Personal Opinion on Plantar Fasciitis

Please read the personal opinion above, again. It is that important.

The plantar fasciitis space is rife for the pickings by the snake oil salesman and over exaggerated claims for products and treatment approaches. It does not matter what treatment they have to sell, X% will get better anyway and that is enough for them to get the anecdotes and the testimonials to make sales and claims. That X% become the champions of the product and *the* treatment for plantar fasciitis. Registered or licensed health professionals are limited and restricted in what they can say publicly and in social media about treatments and their successes and are bound to stay with the boundaries of what the preponderance of scientific evidence says or they put their registration or licensure at risk. Sales people are not bound by such ethics, guidelines and rules.

The ‘Instant cure’ for plantar fasciitis
You do occasionally come across an advertisement or a YouTube video or something promising an instant cure for plantar fasciitis via some special or magical method. That is not possible. Plantar fasciitis (or fasciosis) is an inflammation and/or degeneration of the plantar fascia tissue. That can not be got rid of instantly – it is just not physiological possible. That takes time to get better (some can be quicker than others). If anyone is claiming an instant cure or claiming that what they did instantly fixed their plantar fasciitis, then they are either not being truthful or the diagnosis was wrong and it was not plantar fasciitis. It may have been something else that caused the heel pain that the ‘instant cure’ fixed.

The Placebo Effect and Plantar Fasciitis
You only need to look at the placebo groups in the clinical trials on plantar fasciitis and see how much that they improve! The whole purpose of a clinical trial is to answer the question if the treatment being tested does better than a placebo. This study has shown that the placebo effect in plantar fasciitis is strong, so believing that you are using an effective treatment which may or may not actually be effective is enough to get some improvement. That is why, above, I spent so much on on the personal opinions on plantar fasciitis. The placebo effect goes a long way to explain why so many are convinced that ineffective treatments actually work.

More on Plantar Fasciitis

See these threads on Podiatry Arena on plantar fasciitis. All the research is linked to there and updated as more research becomes available.

Final word on plantar fasciitis

Its all about the loads and vulnerability, ie its a mechanical problem. Mechanical problems need mechanical solutions. Drugs, chemicals, injections, shocks and massages are not mechanical solutions. We also do not ignore the psychosocial context around plantar fasciitis.

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