Comparing treatments for Plantar Fasciitis, Plantar Fasciopathy and Plantar Fascia tears: A review of the research

Ross A. Hauser, MD, Danielle R. Steilen-Matias, MMS, PA-C

When we see patients who have continued problems with plantar fasciitis, we usually see patients who:

In April 2023, doctors writing in the Journal of foot and ankle research (36), described the real life day-to-day experiences of 15 people with long-term plantar fasciopathy. Let’s see what these 15 people have in common with you:

Researchers interviewed the 15 patients and found that “three core themes (main concerns) and ten sub-themes (similar concerns under the main heading – see below).

Conclusions: “Participants revealed how their heel pain led to inactivity and emotional and social challenges. Pain when walking and fear of aggravating it dominated the participants’ lives. They emphasized the importance of finding alternative ways to stay active and avoiding sick leave.” Sound like you?

If you are reading this article it is likely that you have tried many of these treatments/therapies and that you are looking for something else to help because you continue on with this problem.

Discussion points of this article:

Cortisone

Platelet-rich Plasma Therapy

Prolotherapy

Comparing the therapeutic effects of extracorporeal shock wave therapy, platelet-rich plasma injection, local corticosteroid injection, and Prolotherapy for the treatment of chronic plantar fasciitis

extracorporeal shock wave therapy plantar fasciitis

Treatments for Plantar fasciitis

For many people, the various types of plantar fasciitis injection treatments can be very helpful and even make the plantar fasciitis go away entirely or for the most part. Unfortunately, for the patients we see, these treatments did not work. The patients we see came to our clinics because they had become “difficult to treat plantar fasciitis patients,” and were being suggested a possible surgery or other treatments. We do see patients who have had a cortisone injection, it may have worked for them for some time, but the plantar fasciitis returned.

We want to begin this article by going right into a study that will help us understand injection treatments for plantar fasciitis: the September 2018 article published in The Journal of Foot and Ankle Surgery (1) comes from medical university researchers in Turkey.

There is so much in this article we can share that will help you understand your treatment options. So let’s get to it.

Research highlights:

The Results:

This study hits on many points that can help explain why cortisone and extracorporeal shock wave therapy are not long-term treatment options for chronic plantar fasciitis and how PRP and Prolotherapy treatments provide longer relief. This study also gives us the ability to point out helpful treatment guidelines for you toward a more permanent solution to your foot pain.

Later in this article, we will discuss Prolotherapy, injections of simple dextrose, Platelet Rich Plasma therapy, injections of concentrated blood platelets, and healing factors from your own blood and how we use these treatments in combination.

First, we would like to present research on all the options that you may have tried.

Treatments with short-term or little relief value vs treatments with long-term relief value

Plantar Fasciitis foot stretching

It is easy to understand why patients with chronic plantar fasciitis are frustrated. They are often given treatments that provide short-term relief but hurt their chances of long-term relief and the ability to return to activity.

Cortisone shots and anti-inflammatory drugs have been shown to produce short-term pain relief benefits, but both result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration. For example, cortisone will eventually weaken the fascia. If they are not strengthened, a painful heel spur will result.

Kinesio taping and extracorporeal shockwave therapy

Kinesio Taping In Plantar Fasciitis

A January 2021 (2) study published in the International Journal of Clinical Practice compared the effectiveness of low-dye Kinesio-taping, to sham (or placebo)-taping, with Extracorporeal shockwave therapy or alone Extracorporeal shockwave therapy in treating Plantar Fasciitis.

The low-dye Kinesio-taping is a way to apply the tape so that weight pressure is taken off the plantar fascia. The taping method also provides medial ankle arch support.

How did the researchers compare these methods?

First, they divided 45 patients with Plantar Fasciitis into three groups.

Four weeks later all the patients were assessed. The cumulative data then revealed: “Although (the) low-dye Kinesio-taping (method) in addition to Extracorporeal shockwave therapy was more effective on foot function improvement than additive sham-taping and Extracorporeal shockwave therapy alone, it did not provide a significant benefit on pain and heel tenderness because of Plantar Fasciitis.”

So the results of this study did not suggest added benefits.

Corticosteroid Injections, Extracorporeal Shock Wave Therapy, and Radiofrequency nerve ablation

Corticosteroid Injections plantar fasciitis

Let’s quickly point out that corticosteroid injection, extracorporeal shock wave therapy, and nerve ablation (burning the nerves to deaden pain) are not first-line treatments for chronic plantar heel pain and related plantar fasciitis. However, they are treatments offered to patients who have failed to gain any relief from those conservative care treatments mentioned above.

A January 2021 paper published in the medical journal Foot & Ankle International (3) looked at the effectiveness of corticosteroid injection, extracorporeal shock wave therapy, and radiofrequency thermal lesioning (ablation) in patients who did not respond to previous treatments.

Looking back at the results of treatments achieved in 217 previously treated patients, the researchers pulled the charts of:

All the patients had the previous treatments at least six months prior.

The researchers reported: “Pain intensity decreased significantly in all patients. However, it decreased significantly more in the corticosteroid injection and radiofrequency thermal lesioning groups than in the extracorporeal shock wave therapy group. Age, sex, body mass index, calcaneal spur presence, and symptom duration were similar among the 3 groups. No complications were noted. . . ” The takeaway was that the cortisone and radiofrequency nerve ablation provided the best relief. Among this group of treatments. But how does further research compare?

A January 2023 (4) comparison study of plantar fasciitis treatments in 40 patients found significant improvements in terms of pain, functional status, and daily life activities following the administration of either extracorporeal shockwave therapy or low-level laser therapy. Furthermore, low-level laser therapy was found to be significantly more effective in alleviating pain than extracorporeal shockwave therapy in the treatment of plantar fasciitis.

A May 2023 paper in The Journal of foot and ankle surgery (37) compare the effectiveness of prolotherapy with phonophoresis (an ultrasound wave device)  and steroid injection in patients with plantar fasciitis.

Dry Needling better than cortisone

A March 2019 study in The Journal of Foot and Ankle Surgery (5) suggested that dry needling would be as effective as the use of corticosteroid injections for treating Plantar fasciitis. The additional benefit would be avoiding the potential adverse effects of corticosteroids. To prove the point, the researchers of this study took patients diagnosed with Plantar fasciitis and prescribed them a 3-week nonoperative treatment regimen.

First two weeks of the program:

The patients were divided into 2 groups

Patients were assessed in the third week and sixth month.

Dry needling is a needle with no medication.

A January 2022 paper in the journal Physiotherapy theory and practice also tested the effects of dry needling, this time, in combination with stretching exercises.

Summary:

Results:

Conclusion: “These results suggest that the combination of dry needling and stretching exercises can be an effective conservative treatment for plantar fasciitis subjects.”

A January 2023 paper in the Archives of orthopaedic and trauma surgery (6) reviewed surgical treatment options for plantar fasciitis and their effectiveness, In this review, 17 studies involving 865 patients were included. Surgical options considered were open and endoscopic plantar fasciotomy, gastrocnemius release, radiofrequency microtenotomy, and dry needling. All interventions resulted in improvement in VAS and AOFAS scores. No major complications were seen from any treatment modality.

An October 2022 paper in the Journal of sport rehabilitation (7) reviewed data from three studies examining the effectiveness of dry cupping for the treatment of plantar fasciitis. Two studies compared dry cupping to therapeutic exercises and stretching, and one study used electrical stimulation. The researchers found moderate evidence to support the use of dry cupping to improve pain and function in patients with plantar fasciitis.

Plantar Fasciopathy Research – Why is Cortisone still an option?

As in the study above, researchers are constantly trying to prove the effectiveness of one treatment over another to answer the simple question: What treatments work best for Plantar fasciitis and chronic plantar fasciopathy (disease of the plantar fascia)?

Researchers at the University of Northern Iowa wrote in the Journal of Sports Rehabilitation:

“For active individuals, plantar fasciitis is one of the most clinically diagnosed causes of heel pain. When conservative treatment fails, one of the next most commonly used treatments includes corticosteroid injections. Although plantar fasciitis has been identified as a degenerative condition, rather than inflammatory, corticosteroid injection is still commonly prescribed. . . ” (8) They also concluded that PRP injections would be more effective as a choice of treatment.

Doctors writing in the medical journal Rheumatology compared the effectiveness of a number of treatments. This included Platelet Rich Plasma Therapy, shock-wave therapy, and corticosteroid injection.

The researchers discovered a trend that favored the PRP treatment. They noted that Platelet Rich Plasma Therapy, followed by shock-wave therapy, was best in providing relief from pain at 3 months over cortisone. Shock-wave therapy and PRP had similar probabilities of providing pain relief at 6 months. (9)

Doctors in the United Kingdom published comparative research for platelet-rich plasma versus corticosteroid injections in treating plantar fasciopathy. Writing in the journal International Orthopaedics, (10) the UK researchers noted: PRP injections are associated with improved pain and function scores at a three-month follow-up when compared with corticosteroid injections.

Is Cortisone no better than a placebo for restoring function?

This is an August 2019 study from medical university researchers in Australia published in the journal BioMed Central Musculoskeletal Disorders. (11) Here are the learning points of this study:

Hyaluronic Acid and Cortisone results and outcomes are just about the same

A January 2020 study in the Journal of Pain Research (12) suggests both cortisone and Hyaluronic Acid were effective modalities for plantar fasciitis and can improve pain and function with no superiority in 24th-week follow-ups, although cortisone seems to have a faster trend of improvement in the short term.

Endoscopic fasciotomy and cortisone

A January 2020 study in the journal Knee Surgery, Sports Traumatology, Arthroscopy (13) comes from Denmark. In this research, doctors examined the benefit of cortisone and physical therapy vs Endoscopic fasciotomy. The researchers of this study point out that 10-15% of plantar fasciitis patients may require surgery if they had failed cortisone and other conservative care treatments over a 6 month period. Endoscopic fasciotomy is a minimally invasive technique that cuts away at the ligaments at the heel attachment of the fascia to release tension. The researchers found that after failed cortisone/physical therapy treatments, Endoscopic fasciotomy could provide benefits.

We would like to point out that you have to go through 6 months of failed treatments before you would likely be considered for this surgery.

A confusing diagnosis and a condition made worse by cortisone

Many people have excellent success with cortisone. Sometimes it is an initial success and sometimes it is a long-term success. It is also very likely that if you have made it this far into this article cortisone injections did not provide the degree of treatment and symptom relief that you and your healthcare professionals desired for you. When cortisone fails, many times it failed because it was not the right treatment for the right diagnosis.

Here is a sample story emailed to us:

I have been experiencing foot pain for the past two years. Initially, my doctors thought I had plantar fasciitis, but, since none of the conservative care treatments and remedies were working for me, and in fact, because my pain was getting worse, I sought further opinions. I saw an orthopedic specialist and a physical therapist. I have flat feet so I was fitted for custom orthotics but this made the pain worse. One night the pain in my foot was so bad I made an “emergency” visit with another foot specialist to see if I could get any answers. This doctor diagnosed me with Tarsal Tunnel Syndrome and suggested I needed better orthotics, more cortisone injections, and I needed to start wearing a foot splint.

The doctor then proceeded to give me a cortisone injection. My foot swelled up even more and I think the cortisone is now a source of my pain. My pain is now very severe and I cannot walk or stand without enormous discomfort. I walk very little now and only with the aid of a walker.

What are we to make of a case like this?

The story above unfortunately is not a unique tale. It may in fact be a story that describes your current situation. Like the story above, we will often see patients who have been diagnosed with plantar fasciitis only to be later diagnosed with Tarsal Tunnel Syndrome because the proven treatment for plantar fasciitis has failed. Then we may see a patient whose upgrade diagnosis to Tarsal Tunnel Syndrome is now again thought to be a problem of plantar fasciitis when proven nerve entrapment remedies for Tarsal Tunnel Syndrome failed.

What do these patients really have? Tarsal Tunnel Syndrome? The Plantar Fasciitis? Both? Neither?

Many readers of this article will know firsthand of the confusion of diagnosis between Tarsal Tunnel Syndrome and plantar fasciitis and worse, the medical history of a lot of failed treatments.

Metatarsal ligament weakness is manifested by pain at the ball of the feet which often radiates into the toes. This is called metatarsalgia. Chronic metatarsal ligament weakness and arch weakness are known as plantar fasciitis. Fasciitis can cause numbness in the foot and toes in the same areas of pain. Pain and numbness in the foot can also be caused by ligament and tendon laxity in the knee. The lateral collateral ligament can refer to pain and numbness down the lateral side of the leg and foot and the medial collateral ligament down the medial side.

We have a much more extensive article on Tarsal Tunnel Syndrome – please see The Non-surgical approach to treating Tarsal Tunnel Syndrome.

A May 2022 paper in the journal Foot and ankle international (14) explored a comparison between Autologous blood injection (ABI)  combined with dry needling vs dry needling alone in treating chronic plantar fasciitis.

In this double-blinded study of 90 patients, with an average age of about 50 years old, 67% female, with symptoms of plantar fasciitis that had failed to improve with a minimum of 3 months of rehabilitation. Patients were divided into two groups autologous blood injection or an identical dry-needle fenestration-procedure without coadministration of autologous blood.

All participants received identically structured rehabilitation and were followed up at 2, 6, 12, and 26 weeks. There were no significant between-group differences seen at any time point studied. There were a number of statistically significant within-group improvements for local foot pain and function in both groups comparing baseline/follow-up data. Overall, levels of pain improved by 25% by 6 weeks and by 50% at 6 months. There were improvements in some generalized function markers. Activity rates did not change, demonstrating that improvements in pain did not necessarily influence physical activity.

A January 2022 study (15) in the journal Physiotherapy theory and practice revealed the results of a parallel blinded randomized controlled trial. In this study, thirty-seven subjects with plantar fasciitis (forty feet) were enrolled randomly into either the control group (stretching exercise) or the experimental group (stretching exercise plus dry needling). All treatments lasted six weeks and both groups were followed for two weeks. Results suggest that the combination of dry needling and stretching exercises can be an effective conservative treatment for plantar fasciitis subjects.

Non-surgical Nerve Release & Regeneration Injection Therapy and Joint Stabilizing Treatments

Some patients benefit from NRRIT, a nerve hydrodissection technique that releases peripheral nerve entrapments. It is a quick, straightforward process, often with instant results for the patient. First, the practitioner uses ultrasound to identify the nerves being entrapped. Next, a natural solution is injected around the nerve to nourish the nerve and mechanically release it from the surrounding tissue, fascia, or adjacent structures. This treatment would be used in conjunction with Prolotherapy and PRP injections.

In this image, ultrasound shows Nerve Release injection Therapy. In the before image, you can clearly see the entrapped nerve. In the after image the median nerve is released providing nerve pain relief to the patient

In this image, ultrasound shows Nerve Release Injection Therapy. In the before image, you can clearly see the entrapped nerve. After, the median nerve is released, providing nerve pain relief to the patient.

The beneficial effect of Prolotherapy injection and Platelet-Rich Plasma was seen within 3 to 12 months

Positive Effect of Platelet-Rich Plasma on Pain in Plantar Fasciitis over Cortisone

Typical protocol treatment for the problem of plantar fasciitis and plantar fasciopathy would be a possible cortisone injection, foot stretching exercises, and rubbing it with an ice pack or cup among other self-help remedies. These treatments can provide temporary relief but they treat the symptoms and do not assist in the repair of the foot integrity and structural instability. We have seen where cortisone injections can lead to tissue rupture or plantar fasciitis tears.

From a regenerative treatment approach that will help repair and rebuild tissue, we like to use Prolotherapy and Platelet Rich Plasma Therapy. We like to use Platelet Rich Plasma (PRP) because there are studies (as documented in this article)  showing that PRP is superior to cortisone injections long-term. In some studies, it is suggested that within the first 6 months of treatment, cortisone and PRP will provide a similar benefit, but as research indicates, PRP provides better results and the PRP does not threaten the structural integrity of the tissue.

The treatment:

We use ultrasound-guided injection so we get to the right areas. We also use a numbing agent to make sure the patient is comfortable. When we begin treatment we inject along the plantar fascia. We investigate for tendinopathies that may be going down to the insertion of the heel. In some patients, when they step down on the heel they may have more issues than plantar fasciitis. We want to make sure that we address these issues as well. For some patients there may be nerve entrapment, for this, we offer Nerve Release & Regeneration Injection Therapy in addition to Prolotherapy and/or PRP (As explained above).

“Treatment of patients with chronic plantar fasciitis with PRP seems to reduce pain and increase function more as compared with the effect of corticosteroid injection.”

An October 2019 study in the American Journal of Sports Medicine (16) comes from University researchers in the Netherlands. Here the researchers published their observations that: “When nonoperative treatment for chronic plantar fasciitis fails, often a corticosteroid injection is given. Corticosteroid injection gives temporary pain reduction but no healing. Platelet-Rich Plasma (PRP) has proven to be a safe therapeutic option in the treatment of tendon, muscle, bone, and cartilage injuries.”

Here is what the researchers did:

RESULTS:

CONCLUSION: “Treatment of patients with chronic plantar fasciitis with PRP seems to reduce pain and increase function more as compared with the effect of corticosteroid injection.”

“Local injection of platelet-rich plasma is an effective treatment option for chronic plantar fasciitis when compared with steroid injection with long-lasting beneficial effect.”

In November 2019, (17) doctors writing in the Malaysian Orthopaedic Journal wrote:

“Many studies show that steroid injection provides pain relief in the short term but not long-lasting. Recent reports show autologous Platelet-Rich Plasma (PRP) injection promotes healing, resulting in better pain relief in the short as well as long term.” To assess this point, 60 patients were randomized in a double-blind study. Here are the findings:

PRP versus Partial Plantar Fasciotomy surgery and steroid injection

A November 2022 paper in the Journal of clinical medicine (18) wrote: “Platelet-Rich Plasma injection has become a desirable alternative to Partial Plantar Fasciotomy surgery and steroid injection for patients with chronic plantar fasciitis due to its potential for shorter recovery times, reduced complications, and similar activity scores. In this paper, the researchers compared PRP treatment to Partial Plantar Fasciotomy surgery in 16 patients with chronic plantar fasciitis. “Patients treated with PRP injection reported a significant increase in their activity scores, shorter recovery time, and lower complication rates compared to Partial Plantar Fasciotomy surgery. Moreover, with respect to existing literature, PRP may be as efficient as steroid injection with lower complication rates, including response to physical therapy. Therefore, PRP treatment may be a viable option before surgery as an earlier line treatment for chronic plantar fasciitis.”

Plantar Fasciopathy Research – Why are we still thinking PRP is a “one-shot wonder?” One shot of PRP usually does not compare well with one shot of cortisone. However, sometimes it does.

Most times studies on PRP effectiveness even the favorable ones – rely on a single dose treatment and a hope for a “one-shot” wonder. For many suffering from chronic plantar fasciitis, one-shot wonders typically do not provide more permanent relief than a patient is looking for. But as this study points out, the potential for PRP is great – when administered by an experienced provider.

As in the above study, doctors writing in British Medical Bulletin evaluated the evidence for Platelet-Rich Plasma injection as a treatment for chronic plantar fasciopathy. What they found was PRP for treating chronic plantar fasciopathy shows promising results and appears safe. However, the number of studies available is limited to give definite positive results and they would like to see more studies performed. (19)

That study was from 2014. The data from this study was cited in a 2020 research update published in the Journal of Orthopaedic Surgery and Research. (20) In this paper the doctors wrote: “Platelet-Rich Plasma (PRP) had been demonstrated to be useful in achieving helpful effects for plantar fasciopathy. The purpose of this study was to compare the pain and functional outcomes between PRP and corticosteroid or placebo for plantar fasciopathy through meta-analysis and provide the best evidence.”

The search for the best evidence

In this paper, the doctor reviewed previously published research to include articles regarding comparative research about the outcomes of PRP therapy and corticosteroid or placebo injection. The conclusion of this research? The doctors wrote: “No superiority of PRP had been found in well-designed double-blind studies, whereas it is implied that the outcomes of PRP are better than placebo based on available evidence.” In other words, the research does not match the clinical experience.

In other research, doctors say they can’t tell if PRP works because there is no standardized treatment technique and that based on “one-shot wonders” it doesn’t appear to be effective over other treatments. (21) Enough so that some researchers want cortisone under ultrasound guidance restored as the primary treatment for plantar fasciitis, (22) despite conflicting research as reported above and here:

Recent research contradicts that sentiment of restoring cortisone as a primary treatment for plantar fasciopathy. Doctors in the UK say “PRP is as effective as steroid injection at achieving symptom relief at 3 and 6 months after injection, for the treatment of plantar fasciitis, but unlike steroids, its effect does not wear off with time. At 12 months, PRP is significantly more effective than steroids, making it better and more durable than cortisone injection.” (23)

Further research in the Singapore Medical Journal (24) suggests it is evident that the effects of corticosteroid injections are usually short-term, lasting 4-12 weeks in duration. Complications and side effects such as plantar fascia rupture are uncommon, but physicians need to weigh the treatment benefits against such risks.

Another study says one shot of PRP can be very helpful

Here we have an October 2020 study published in the Indian Journal of Orthopaedics (25). Here are the learning points:

Here the doctors examined thirty people with unilateral (one foot) plantar fasciitis patients with symptom duration of 6 months or more were included in the study. Results: “The short-term results of single-dose PRP injections shows clinical and statistically significant improvements in VAS (0-10 pain score) for heel pain, functional outcome scores, and plantar fascia thickness. . .  This study concludes that local PRP injection is a viable management option for chronic plantar fasciitis.”

Summary research study on PRP

A February 2022 study in The Journal of Foot and Ankle Surgery  (26) wrote: “There is evidence to support the use of PRP compared to corticosteroid or placebo, especially at longer terms such as at 3, 6, and 12 months.” The researchers base this on a review of the most recent literature that found pain scores reduced. They also note: “While PRP and corticosteroid can both decrease inflammation, PRP has biological regenerative properties such as augmenting cellular migration, enhancing cellular proliferation, and promoting angiogenesis [formation of new blood vessels].

Prolotherapy plantar fasciitis treatment and Prolotherapy or PRP for plantar fasciitis?

Prolotherapy, like PRP, repairs plantar fasciitis by strengthening the fascia and providing support to the arch of the foot. Prolotherapy is a treatment that regenerates and strengthens weakened structures, such as the weakened plantar fascia ligament.

When a patient comes in with plantar fasciitis, an evaluation is made as to what type of treatments will likely benefit the patient most. Often times we will look for the simplest treatment. In many cases, simple dextrose Prolotherapy will do the trick. Sometimes a stronger proliferant solution like PRP is required.

Research:

In April 2020, researchers at the University of Health Sciences in Turkey published these findings in the American Journal of Physical Medicine and Rehabilitation (27) on the evaluation of the efficacy of dextrose Prolotherapy in the treatment of chronic resistant plantar fasciitis through comparison with a control group.

Korean doctors writing in PM & R: The Journal of Injury, Function, and Rehabilitation compared Prolotherapy to PRP in the treatment of chronic recalcitrant plantar fasciitis. Led by the Korea National Sports University, the researchers found all patients in both the Prolotherapy group and the PRP group showed significant improvements. They concluded: “Each treatment seems to be effective for chronic recalcitrant plantar fasciitis, expanding the treatment options for patients in whom conservative care has failed. PRP treatment also may lead to better initial improvement in function compared with dextrose Prolotherapy treatment.”(28)

Prolotherapy treatments need to focus on the spring ligament which is also called the plantar calcaneonavicular ligament. This is one of the most important ligaments in the arch that supports the arch. But whether someone has a high arch, normal arch, flat arch, or pes planus, if they have pain and tenderness to palpation, typically they’ll respond great to Prolotherapy because Prolotherapy stimulates the repair of the injured areas. It causes the proliferation of injured soft tissue so they repair.7416

The atrophy of the arch or spring ligament is a problem of plantar fasciitis

spring ligament is a problem of plantar fasciitis

A December 2021 study in the medical journal Foot (29) comes to us from Morinomiya University of Medical Sciences in Japan. Here the doctors made a connection between atrophy of the spring ligament and thickening of the plantar fascia.

“Although patients with plantar fasciitis show spring ligament laxity, the thickness of the spring ligament in patients with plantar fasciitis remains unclear. This study aimed to (understand) the morphological characteristics of the spring ligament in patients with plantar fasciitis based on an ultrasound imaging system.

Thirty feet of 30 patients (painful group) diagnosed with plantar fasciitis at our hospital and thirty feet of 30 healthy volunteers (healthy group) without plantar pain were investigated.

The thicknesses of both the spring ligament and plantar fascia were assessed via ultrasound and a statistical comparison of the spring ligament and plantar fascia thickness between the painful and healthy groups was assessed.

The spring ligament thickness in the painful group was significantly lower than that in the healthy group. The thickness of the plantar fascia in the painful group was significantly greater than that in the healthy group. In addition . . .the thicker the plantar fascia in the subjects, the thinner was the spring ligament.

In this study, the ultimate suggestion was that insoles at an early stage could prevent the onset of plantar fasciitis. We suggest the early intervention of Prolotherapy.

Prolotherapy or extracorporeal shock wave therapy?

In this study, (30) researchers explored treating chronic plantar fasciitis patients with Prolotherapy or extracorporeal shock wave therapy.

Study learning points:

A February 2022 study in The Journal of Foot and Ankle Surgery (31) also compared the effectiveness of extracorporeal shockwave therapy (ESWT) versus dextrose Prolotherapy on pain and foot functions in patients with chronic plantar fasciitis

Results of three ESWT sessions versus three single injections of dextrose:

One injection of cortisone and one injection of Prolotherapy

Plantar fasciitis is more of a misnomer since “itis” means inflammation, and most patients who have been diagnosed with plantar fasciitis actually have a weakened, degenerated plantar fascia. The true inflamed tissue is hot to the touch, red, and swollen. Thus, the anti-inflammatory treatments do not promote repair and healing of the fascia because most cases of this type of foot pain are not truly inflammatory.

A study from 2021 published in the journal Foot and Ankle Specialist (32) compared one injection of cortisone and one injection of dextrose.

We would like to point out that a single injection of dextrose should not be considered a Prolotherapy treatment. It should be considered a single shot of dextrose. A single Prolotherapy treatment would be considered a “peppering of the area,” with the needle to address the ligaments and tendon attachments as described above.

Let’s however see how one injection of dextrose did against one injection of 40 mg methylprednisolone.

One injection of dextrose was just as good as one injection of cortisone by 12 weeks.

The relationship between plantar calcaneal spurs (Heel Spurs) and Plantar fasciitis

Plantar fasciitis is one of the most common causes of heel pain. Plantar fasciitis involves pain and inflammation of the plantar fascia, a flat band of tough tissue supporting the arch of the foot that runs from the heel to the base of the toes. It looks sort of like a series of fat rubber bands, but the plantar fascia is made of collagen which is rigid and non-stretchy. Plantar fasciitis is common in middle-aged people but also occurs in younger people who are on their feet a lot. When the plantar fascia is strained, it becomes weak, swollen, and irritated.

Heel spur formation. Weakness in the plantar fascia (called plantar fasciitis) causes inflammation to occur at the calcaneal attachment, causing a heel spur.

Repeated microscopic tears of the plantar fascia cause pain that is most notable in the morning after getting out of bed. Putting weight on the injured area after periods of rest (such as sleep) will cause stress on the area and a more sudden, aching pain.  Once the foot loosens up, the pain generally decreases. The pain may return, however, after long periods of standing, or after another period of rest. Plantar fasciitis may also be called “heel spurs,” but this is not always accurate because bony growths on the heel may or may not be involved.

In the medical journal Foot and Ankle Injury, (33) doctors in the United Kingdom point out the confusion foot specialists face when understanding the relationship between a heel spur and plantar fasciitis. Here is what they write:

So how did this research team come up with the answer? By comparing soft tissue ligament instability. Does weakness in the soft tissue cause bone spur formation? Our website is filled with research that it does, of course, do so.

This is what the researchers did:

Studies like these give fantastic examples of the problems of joint instability and the body’s way of dealing with it at the point of the problem.

Note: Heel spurs are due to weakened ligamentous support of the plantar fascia. Prolotherapy to strengthen the plantar fascia will eliminate chronic heel pain. There is generally no need for heel spurs to be surgically removed after the supportive ligaments and plantar fascia have been repaired.

Then again, some people with heel spurs have heel pain, and some people with heel spurs have no heel pain. Is the presence of the heel spur confusing the treatment options?

Doctors at the University of Auckland and the Department of Orthopedic Surgery, Wellington Hospital in New Zealand published a comprehensive opinion on how to treat heel spurs. This paper was published in the Journal of Anatomy. (34)

Plantar fascia tears

In this video, Danielle R. Steilen-Matias, MMS, PA-C, discusses typical treatments for Plantar Fascia tears.

Summary:

Summary and contact us. Can we help you?

Most recently a March 2022 review study (35) found “dextrose prolotherapy is an effective treatment of chronic plantar fasciitis to reduce pain, improve foot functional score and decrease plantar fascia thickness at short-term follow-up.” The paper also tells us that further studies in larger populations are needed to identify the optimal treatment regimen including dextrose concentration, volume, injection site, injection technique, and the number of injections required. The long-term effects of these treatments also require further examination.

We have almost three decades of experience in the use of Prolotherapy and case histories of nearly thirty years. Prolotherapy can be an effective treatment for Plantar Fasciitis.

We hope you found this article informative and that it helped answer many of the questions you may have surrounding your Plantar Fasciitis, Plantar Fasciopathy, and Plantar Fasciitis tears problems.  If you would like to get more information specific to your challenges of peroneal tendon injury and ankle instability, please email us: Get help and information from our Caring Medical staff

 

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References:

1 Uğurlar M, Sönmez MM, Uğurlar ÖY, Adıyeke L, Yıldırım H, Eren OT. Effectiveness of Four Different Treatment Modalities in the Treatment of Chronic Plantar Fasciitis During a 36-Month Follow-Up Period: A Randomized Controlled Trial. The Journal of Foot and Ankle Surgery. 2018 Sep 1;57(5):913-8. [Google Scholar]
2 Bahar‐Ozdemir Y, Atan T. Effects of Adjuvant Low‐Dye Kinesio Taping, Adjuvant Sham Taping, or Extracorporeal Shockwave Therapy Alone in Plantar Fasciitis: A Randomized Double‐Blind Controlled Trial. International Journal of Clinical Practice. 2020 Nov 29:e13993. [Google Scholar]
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This article was updated February 1, 2023

 

 

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