We have seen a lot of patients with plantar fasciitis. If you have been diagnosed with plantar fasciitis you probably do not need to know what it is or how you got it. You have it now and you know what it is, painful and restrictive. You also know what is not helping you and maybe thinking about surgery.
Is it the heel spur causing pain?
When a patient comes into our office with plantar fasciitis and a bone or heel spur revealed on an x-ray or an MRI. The first thing they want to know is can we get rid of the bone spur? I usually have to do a little convincing that it is not the bone spur that is causing them their pain and that heel spur is not the issue we want to tackle at the start of the treatment. I explain to the patient that the issue is that you’re overdoing an activity which is irritating the place where the fascia (the soft tissue that connects the toes to the heel) meets the heel bone. When that irritation is constant and chronic, bone spurs form. We want to treat that problem.
Some people with heel spurs have pain, some people with heel spurs have no pain
There was an interesting study published recently in the Journal of Anatomy. (1) It is a very detailed analysis of heel spurs. Listen to what these researchers said:
- Bone spurs can cause painful heels in some patients. However, many people with bone spurs in the heel have no painful symptoms that can be pinpointed to the bone spur. The pain is coming from somewhere else.
- Many things can cause the formation of heel spurs including tears in the plantar fascia and plantar fasciitis.
- Plantar fasciitis is hypothesized to be due to mechanical overload of the Plantar fascia resulting in microtears; the repeated trauma from heel strike does not allow the foot to heal itself and results in a chronic fascial inflammatory condition.
- Heel spurs are present in 45–85% of those with plantar fasciitis; they also share a number of risk factors such as obesity and advancing age, suggesting that the two may be linked.
- However there is little evidence of an active inflammatory response suggesting that this condition is more of a degenerative fasciosis rather than an inflammatory fasciitis.
In many people, plantar fasciitis is not an “itis,” or an inflammation problem, but an “osis,” a degenerative problem that anti-inflammatories will not help in the long run.
Knowing the thickness of the plantar fascia may not be helpful to successful treatment
A patient will come in, they have an MRI report that talks about plantar fascia thickening. That problem, they have been told, is THE problem. Anti-inflammatories will be recommended. A 2018 study says, not so. Plantar fascia thickening is NOT THE problem. At the Istanbul Training and Research Hospital in Turkey doctors reported the findings of their study (2):
- “Measuring of plantar fascia is not helpful as a diagnostic or prognostic tool and MRI imaging should be reserved for differential diagnosis.”
Surgery? “Open plantar fascia release is of questionable clinical value and that patients may improve in the natural course of the disease, in spite of surgery.”
Surgeons in the United Kingdom wondered why “successful” partial plantar fascial release surgical techniques were not as successful as they would have thought. This is what they said in their research (3):
“Plantar fasciitis is thought to be a self-limiting condition best treated by conservative measures, but despite this many patients have a prolonged duration of symptoms and surgery may be indicated. Partial plantar fascial release is reported to have a short-term success rate of up to 80%, but anecdotally this was not thought to represent our local experience.”
“A prolonged recovery period and generally poor outcomes leads the authors to suggest that open plantar fascia release is of questionable clinical value and that patients may improve in the natural course of the disease, in spite of surgery.”
We have seen good success in many patients treated with PRP and stem cells for their plantar fasciitis. A video of the technique is shown here:
PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. PRP puts specific components in the blood to work. Blood is made up of four main components; plasma, red blood cells, white blood cells, and platelets. Each part plays a role in keeping your body functioning properly. Platelets act as wound and injury healers. They are first on the scene at an injury, clotting to stop any bleeding and immediately helping to regenerate new tissue in the wounded area.
Stem Cell Therapy is the injection of a damaged area of the body with stem cells that have been drawn from the patient’s own bone marrow or from donated umbilical cord blood. Stem cells are “de-differentiated pluripotent” cells, which means that they continue to divide to create more stem cells; these eventually “morph” into the tissue needing repair — for our purposes, collagen and soft tissue such as fascia.
Often I am asked to these treatments to cortisone. Simply, we prefer the regenerative medicine techniques of PRP and stem cells vs. cortisone. We have over 20 years experience in seeing the clinical results.
A study in the Journal of Foot and Ankle Surgery helps explain: (4)
- Previous studies have shown the superiority of Platelet-rich plasma (PRP) over corticosteroids for chronic plantar fasciitis.
- The aim of this study was to compare the pain and functional outcomes of PRP with cortisone and placebo injections for the treatment of chronic plantar fasciitis.
- 90 patients:
- PRP (n = 30 patients),
- Cortisone (n = 30 patients),
- and placebo (n = 30 patients).
- The patients were followed at regular intervals until 18 months postinjection
- Cortisone showing significantly better improvement than PRP in the short term, whereas longer-term PRP was significantly better than CS.
- In summary, both PRP and Cortisone are safe and effective treatment options for chronic plantar fasciitis, showing superior results to placebo treatment. The longer-term results and less reinjection and/or surgery rate of PRP makes it more attractive as an injection treatment option versus CS injection.
The treatment of Plantar Fasciitis requires a physical examination and a look at how this problem is impacting you. If you were to come into my office we would assess and evaluate your situation and discuss the realistic healing options possible.
Ask Dr. Darrow about your Plantar Fasciitis
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1 Kirkpatrick J, Yassaie O, Mirjalili SA. The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations. J Anat. 2017 Jun;230(6):743-751. doi: 10.1111/joa.12607. Epub 2017 Mar 29. PubMed PMID: 28369929; PubMed Central PMCID: PMC5442149.
2 Ermutlu C, Aksakal M, Gümüştaş A, Özkaya G, Kovalak E, Özkan Y. Thickness of plantar fascia is not predictive of functional outcome in plantar fasciitis treatment. Acta Orthop Traumatol Turc. 2018 Nov;52(6):442-446. doi: 10.1016/j.aott.2018.01.002. Epub 2018 Oct 9. PubMed PMID: 30314878; PubMed Central PMCID: PMC6318475.
3. MacInnes A, Roberts SC, Kimpton J, Pillai A. Long-term outcome of open plantar fascia release. Foot & ankle international. 2016 Jan;37(1):17-23.
4. Shetty SH, Dhond A, Arora M, Deore S. Platelet-Rich Plasma Has Better Long-Term Results Than Corticosteroids or Placebo for Chronic Plantar Fasciitis: Randomized Control Trial. The Journal of Foot and Ankle Surgery. 2019 Jan 1;58(1):42-6.
There is controversy in the medical community about umbilical cord blood stem cells. Some insist that the injectable solution contains abundant live umbilical cord blood stem cells. Some suggest that the stem cells are not alive. I have seen the flow cytometry showing live stem cells. The research shows that these stem cells release cytokines and growth factors that awaken native stem cells. I have tried this treatment on myself for both shoulders and knees. After great success, I started using this treatment on patients. I still use PRP and bone marrow depending on the patient’s pathology and requirements. To date the results are excellent for all of these treatments. We are in the process of doing a study on cord blood stem cells (we have done others on bone marrow and PRP) to see which treatments are the most successful. We are awaiting more long term results.