Plantar Fasciitis Plantar Fasciitis: Diagnosis and Therapeutic Considerations

Plantar fasciitis is the most common cause of inferior heel pain. The pain and discomfort associated with this condition can have a dramatic impact on physical mobility. The etiology of this condition is not clearly understood and is probably multi-factorial in nature. Weight gain, occupation-related activity, anatomical variations, poor biomechanics, overexertion, and inadequate footwear are contributing factors. Although plantar fasciitis is generally regarded as a self-limited condition, it can take months to years to resolve, presenting a challenge for clinicians. Many treatment options are available that demonstrate variable levels of efficacy. Conservative therapies include rest and avoidance of potentially aggravating activities, stretching and strengthening exercises, orthotics, arch supports, and night splinting. Other considerations include use of anti-inflammatory agents, ultrasonic Shockwave therapy, and, in the most extreme cases, surgery. This article reviews plantar fasciitis, presents the most effective treatment options currently available, and proposes nutritional considerations that may be beneficial in the management of this condition. (Altern Med Rev 2005;10{2):83-93) Introduction Description Plantar fasciitis (PF) is a degenerative syndn)me of the plantar fascia resulting from repeated trauma at its origin on the calcaneus.' PF is reported to be the most common cause of inferior heel pain in adults.Other names for PF include painful heel syndrome, heel spur syndrome.^ runner's heel, subcalcaneal pain, calcaneodynia. and calcancal periostitis.^ The word "fasciitis" assumes inflammation is an inherent component of this condition. However, recent research suggests that some presentations of PF manifest non-inflammatory, degenerative processes and should more aptly be termed "plantar fasciosis.""'•'' In the United States, more than two million individuals are treated for PF on an annual basis, accounting for 11-15 percent of professional visits related to foot pain." It is estimated that 10 percent ofthe U.S. population will experience plantar heel pain during the course of a lifetime.^ PF affects individuals regardless of sex. age. ethnicity, or activity level. It is seen in physically active individuals such as runners and military personnel, but is also prevalent in the general population, particularly in women ages 40-60.-^'' Etiology and Pathophysiology The plantar fascia is a thickened fibrous sheet of connective tissue that originates from the medial tubercle on the undersurface ofthe calcaneus and fans out. attaching to the plantar plates of the metatarsophalangeal joints to form the medial longitudinal arch of the foot. It provides key functions during running and walking. In general, the purpose of the plantar fascia is twofold to provide support ofthe longitudinal arch and to serve as a dynamic shock absorber for the foot and entire leg. As one walks, the heel makes contact with the ground. Just after this contact, the tibia turns inward and the foot pronates. stretching the plantar fascia and tlattening the arch. This allows the foot to accommodate for irregularities in the walking surface Mario Roxas, ND Technical Advisor. Thome Research; Associate Editor, Alternative Medicine Review. Private practice, Beaverton, OR. Correspondence Address: 11385 SW Scholis Ferry Rd., Beaverton OR 97008 Email: [email protected] Alternative Medicine Review • Volume 10, Number 2 • 2005 Page 83