Conservative Care for Plantar Fasciitis



Conservative Care for Plantar Fasciitis

The efficacy of nonsurgical methods in the early management and treatment of plantar fasciitis has been documented extensively in medical literature.

A comprehensive examination of the lower extremity in addition to an individualised assessment of risk factors should serve as a prelude to the implementation of successful preventative strategies.

Immobilisation in the form of decreased weightbearing on the strained plantar fascia helps to alleviate pain and allows for sufficient healing of the affected ligament in the initial stages of treatment.

Cryotherapy aids in minimising inflammation to provide short-term relief from the pain and discomfort associated with the condition.

The importance of engaging in a stretching programme for the gastrocnemius and soleus muscles in the treatment for plantar fasciitis was highlighted by Mark Silvester in the Journal of Bodywork & Movement Therapies.

A lack of dorsiflexion at the talocrural joint during gait can lead to compensatory hyperpronation of the foot, straining the plantar fascia; this makes it essential to correctly align the lower limbs first to ensure calf muscle stretches do not put any additional strain on the plantar fascia.   

The author further emphasised the need to better understand the relationship between calf muscle shortness, plantar fasciopathy and lower limb alignment in order to obtain the most from any therapeutic programmes for plantar fasciitis.

Rathleff et al. demonstrated the benefits of including high-load strength training in treatment modalities for patients with plantar fasciitis by studying forty-eight individuals with the condition.

Subjects were randomised to shoe inserts and daily plantar-specific stretching (the stretch group) or shoe inserts and high-load progressive strength training (the strength group) performed every second day; high-load strength training consisted of unilateral heel raises with a towel inserted under the toes to further activate the windlass mechanism.

A larger improvement in foot function index (FFI) from baseline to primary endpoint at 3 months was observed in the strength group leading the authors to conclude that controlled high-load tensile forces across the plantar fascia can be associated with improvements in symptoms of degenerative conditions such as plantar fasciitis.

Hilda Alcântara Veiga Oliveira, from the Rheumatology Division at the Federal University of São Paulo, was able to establish the clinical effectiveness of full-contact orthotics in the treatment of plantar fasciitis by conducting a double-blind randomised controlled trial with seventy-four patients.

A statistically significant difference was observed over time for pain while walking, with patients being able to achieve greater walking distance with full-contact orthotics.

The total contact insoles were chosen for the fact that these could reproduce the medial and anterior longitudinal arches of the patient’s foot without load, thereby maintaining the best physiological shape possible.

One of the many benefits of including highly customised, full contact MASS4D® foot orthotics as part of a treatment programme for plantar fasciitis is the supportive force provided to the foot to prevent the plantar fascia from stretching any further and to enable stabilisation of the medial longitudinal arch.

This helps in reducing any additional stress to the inflamed ligament, allowing it to heal and restoring optimal functionality in the feet to prevent future recurrences.

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References:

  1. Silvester M. (2017) Calf Stretching in Correct Alignment. An Important Consideration in Plantar Fasciopathies. Journal of Bodywork & Movement Therapies: 2017, Vol. 21, pp. 212-215
  2. Oliveira H. A. V., Jones A., Moreira E., Jennings F., Natour J. (2015) Effectiveness of Total Contact Insoles in Patients with Plantar Fasciitis. The Journal of Rheumatology: March 2015, Vol. 42, No. 5, DOI:10.3899/jrheum.140429
  3. Rathleff M. S., Mølgaard C. M., Fredberg U., Kaalund S., Andersen K. B., Jensen T. T., Aaskov S., Olesen J. L. (2014) High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scandinavian Journal of Medicine and Science in Sports: September 2014, DOI: 10.1111/sms.12313

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