Plantar Fasciitis the Latest Scientific Research, Orthotics Thumbs Up or Thumbs Down & What Else Can You Do!

Article by G Rieger Posted February 4, 2015 Last Updated May 11, 2017

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Plantar Fasciitis has been estimated to affect approximately 10% of the US population at some point during their lives.  Those who participate in recreational running or any running related sport are much more likely to experience this condition on one or more occasions.  Some naturopathic physicians believe that a significant number of patients who are diagnosed with heel spurs actually are suffering from plantar fasciitis.

It is estimated that over 2 million Americans visit a Podiatrist every year with complaints of foot pain.  The most common treatment plan involves orthotics and many doctors’ offices today are simply prescribing generic orthotics or those from soft foam or clay impression rather than custom manual gait analysis performed by a Board Certified Pedorthist.  As amazing as this may seem, the more interesting piece of information is that most scientific studies show a margin of acute pain reduction but no increase in the prevention of injury. (*McKenzie et al.)  Other therapeutic treatment would be called for within a comprehensive treatment of acute plantar fasciitis.

Custom orthoses have their place in the care of specific conditions and considerations, such as diabetic foot protection, correction of genetic structural deviations or to support an individual’s postural changes that accompany a severely degenerated joint. A study conducted on US marines followed the impact of specially designed running shoes based specifically on the shape of the plantar surface of each marine and compared the injury rate against another group of marines with standard running foot ware(*Knapik et al.)  The study found no reduction in injury rates with the plantar patterned running shoe.  There is a wide degree of difference between foam, clay foot box impressions, or the latest foot scanning stations and a professional analysis performed by a Certified Pedorthist CPO or Certified Orthotist CO. (*Telfer et al.)

A podiatrist is a medical doctor spending years learning how to diagnose foot conditions, related disease and how to perform corrective surgeries.  They are not always educated in detailed analysis and production of orthotics.  The media has muddied the waters were orthotics are concerned by delivering multiple articles sighting poorly conducted studies backed by the makers of generic orthotics, blurring the lines in the minds of many patients. A Certified CPO or CO is a trained and skilled practitioner with both science and a skilled artistic eye on their side. The production of the best orthotics are truly based on art and science. 

The unfortunate situation is in those podiatrists that have taken the easy and profit driven path of generic orthotics.  It is important to note that North American Doctors of Podiatry tend to be focused on corrective surgeries and our Universities provide this focus within their doctoral programs.  From an international perspective other podiatrists from around the world tend to come from a biomechanical perspective and training, with a greater attention paid to the art of the pedorthist and orthotist. 

To find an American Board for Certification of Orthotics, Prosthetics, and Pedorthics Pedorthist click on the link above.  To find a Canadian Certified Pedorthist go to the Pedorthic Association of Canada.   The scientific evidence supports the use of quality plantar surface specific orthotics in the treatment of plantar fasciitis.  Thumbs up to custom fitted orthotics and neutral on over the counter generic shoe inserts.  A comprehensive treatment protocol including other therapeutic options can provide the best results.

Plantar Fasciitis What Can You Do?

The best news about plantar fasciitis is that when it is addressed immediately after onset a quick recovery is often the result.  Deep tissue plantar surface massage is a first step.  Find a qualified massage practitioner or use one of the following DIY foot massage techniques.

  • Use a Frozen Water Bottle by slowly rolling your foot over the surface with variable pressure (bonus helps reduce inflammation)
  • Use a Water Noodle floatation toy by slowly rolling your foot over the surface with variable pressure
  • Use a Rolling Pin by slowly rolling your foot over the surface with variable pressure
  • Use a Tennis Ball or Baseball by slowly rolling your foot over the surface with variable pressure

Next stretch in the morning before you get out of bed and several other times throughout the day.  The use of a step or block can be utilized to extend the foot into dorsi flexion while extending the toes toward the shin, as well as a belt, strap, rope or Thera-band.  A key component that will facilitate the effectiveness of the stretch is to reach the fully stretched position and hold for only one and a half seconds.  You will find other sources recommend 15 to 30 seconds.  The goal of holding the stretch for a short one and a half seconds is to prevent the golgi tendon organ found in the Achilles tendon from triggering a stretch reflex.

The Achilles tendon anchors the gastrocnemius, plantaris and soleus muscles to the calcaneous bone or heel of the foot and is continuous with the plantar fascia. These muscles are responsible for allowing you to point your foot down into plantar flexion at the ankle and can become pathologically contracted resulting in plantar fasciitis. (*Patel et al.) Tibialis anterior with some assistance from the stirrup muscles allows you to bring your ankle toward your shin in dorsi flexion.  When experiencing a prolonged case of foot pain that has become chronic or is combined with reduced range of motion within the ankle, it is always best to consult your local physician and request a referral to a podiatrist for consultation.  

The Golgi tendon organ is a reflex intended to protect the fascia, tendons and skeletal muscles form rupture by causing them to contract.  When the Achilles tendon contracts it shortens the plantar fascia.  By avoiding this reflex and increasing reps one can stretch and lengthen the plantar fascia and musculature.

Now that you have used deep tissue massage as well as ice therapy via a frozen bottle it's time to consider nutrition.   A grounded anti-inflammatory diet is the secret to quick recovery and vital for prevention under most conditions.  A low processed foods diet with no GMO's and Gluten Free with the inclusion of inflammation reducing foods, herbs, minerals, vitamins and supplements.

Three key nutrients for recovery from plantar fasciitis are topical magnesium lotion or oil, pantothenate acid (B5) and omega 3 fatty acids.  Magnesium will not only help relax the foot musculature but will also calm the nervous system and provide a vital nutrient to the fascia.  Both B5 and Omega 3 fatty acids are anti-inflammatory helping in the overall healing process and your all around health.

The last consideration is foot musculature overall strength and balance. Strengthening the foot muscles can go a long way towards prevention as well as recovery.  Just remember that strengthening the musculature alone will not provide a comprehensive treatment protocol for Plantar Fasciitis. (*Riddle et al.) Orthotics may be called for depending on your particular situation and needs.  Make sure you find a qualified manufacture of custom orthotics before you buy.

The following video from Dr. Josh Axe's YouTube Channel Offers  a comprehensive Treatment Protocol for Plantar Fasciitis

References and Resources *

  • Knapik et al. "Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training". American Journal of Sports Medicine. 2010.
  • McKenzie et al. "Running shoes, orthotics and injuries".  Sports Medicine. 1985, 2(5):334–347. 
  • Patel et al."Association between plantar fasciitis and isolated contracture of the gastrocnemius." Foot Ankle Int. 2011; 32(1):5-8.
  • Riddle et al. . "RE. Risk factors for plantar fasciitis: a matched case-control study." J Bone Joint Surg Am. 2003; 85-A(5):872-877.
  • Telfer et al. "Computer-aided design of customized foot orthoses: reproducibility and effect of method used to obtain foot shape".  Archives of Physical Medicine & Rehabilitation2012 May;93(5):863-70.   

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