Plantar Fasciosis (Heel Pain) – What Works Best?

The condition is more about the body’s natural healing response being overloaded by imposed demands.¹ Therefore, plantar fasciosis works as a more apt term for the world’s most common cause of heel pain. This helps explain why recurrence is high and one in five cases is still symptomatic after a year.  

What is Plantar Fasciosis?

Whether we call it plantar fasciitis or plantar fasciosis, the diagnosis refers to pain and tenderness in the thick, elastic band of tissue at the bottom of the foot (plantar fascia) where it attaches to the heel bone (calcaneus). The pain may be worse in the morning, when standing up after long periods of sitting, or after long periods of standing. The pain may subside with activity (aka warming out of it). The condition is more common among runners, but it is also increased by high body weight. People with flat feet are more prone to plantar fasciosis.

What Works Best for Plantar Fasciosis?

Research finds a number of approaches to be effective or at least partially effective in overcoming this painful condition. Interestingly, until very recently, no one had ever compared these treatments, in isolation, against each other to see which was most effective. So Ravi Gupta (Department of Orthopaedics, Government Medical College Hospital, Chandigarh) and colleagues set out to do just that. Their results were published this past February in the Indian Journal of Orthopaedics.²

Gupta et al. gathered 140 patients with plantar fasciosis. Subjects had heel pain for an average of six to seven months – some as long as four years! They divided the patients into four groups. Each group received one and only one type of treatment: (1) analgesics (pain meds), (2) hot-water fomentation & silicon heel pads, (3) plantar fascia stretching, or (4) calf stretching. At one-year follow-up, all four groups showed statistically significant improvements in pain and disability. Unsurprisingly, analgesics proved to be the least effective treatment in terms of pain reduction. These would do nothing to alleviate an overloaded healing response in the plantar fascia. Plantar fascia stretching stood out as the most effective treatment for reducing disability. In terms of pain and disability, the four treatments ranked as follows:

Most effective: plantar fascia stretching

More effective: heat & silicone heel pad

Effective: calf stretching

Least effective: analgesics

These results are interesting and helpful to physiotherapists who need to develop effective treatment plans. They do not reflect a full treatment plan for plantar fasciosis. This would typically involve ergonomic consultation, thermal modalities, targeted stretching, and other effective treatments designed to work in combination. In fact, one of the things research has proven about plantar fascia treatment is that programs supervised by a physiotherapist achieve better results than programs that patients conduct independently after initial consultation.³

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References

1. Ramamoorthy EN, Daniels JM, Kukkar N. Challenges in Diagnosis of Plantar Fasciosis (Fasciitis). Ann Sports Med Res. 2016;3(7):1086.
2. Gupta R, Malhotra A, Masih GD, Khanna T, Kaur H, Gupta P, Kashyap S. Comparing the role of different treatment modalities for plantar fasciitis: a double blind randomized controlled trial. Indian Journal of Orthopaedics. 2020 Feb;54(1):31-7.
3. Almubarak AA, Foster N. Exercise therapy for plantar heel pain: A systematic review. International Journal of Exercise Science. 2012;5(3):9.