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Laser Treatment for Plantar Fasciitis

Dec 20, 2022

We are often asked what is the most effective treatment for plantar fasciitis?

Plantar fasciitis (PF) is estimated at 10%, most commonly affecting 40 to 60 years, especially including women, athletes, and over weight individuals and those whose job makes them spend lots of time on their feet such as soldiers, nurses and policemen. Typically, people suffer pain for the first steps in the morning which improves with moderate activity, but symptoms are aggravated due to prolonged weight-bearing activity.

Various factors are thought to contribute to Plantar Fasciitis, including biomechanical dysfunction, pes planus (flat feet), mechanical overload, obesity, improper shoe fit and wear. Decades ago, it was thought that inflammatory responses played a vital role in the pathological process. However, newer, emerging studies suggest that it is a degenerative process.

As with many things in the medical world, no one single treatment has been demonstrated to consistently give the best result, so there is not a one size fits all or systematic approach for treating plantar fasciitis.

This is due to individuals responding in different ways to different treatments, each person having slightly different presentations. It has, however, been shown that over the counter anti-inflammatory medication and a ‘wait and see’ approach is the least successful intervention. In fact there is some evidence to suggest that delaying treatment can prolong pain for longer.

As a result it is difficult to give general advice as treatment is specific to the individual, other than a don’t leave it and hope it gets better approach which will often make it last longer than necessary.  It is why a thorough initial consultation is so important as it will allow for a bespoke treatment plan to be put together to give the best treatment for you and your particular presentation.  It is also why plantar fasciitis forums on social media can be dangerous, as untrained members of the public tell other people how to fix their plantar fasciitis based on their personal experience, rather than understanding the particular individual’s presentation.  There are many treatment methods that can be used to help cure plantar fasciitis including foot mobilisations, fascial manipulation, laser treatment, and shockwave treatment.  By putting together the right treatment package for the individual good results can be achieved.

How plantar fasciitis develops…

The plantar fascia is a band of tissue (fascia) that connects your heel bone to the base of your toes. It supports the arch of the foot and absorbs shock when walking. Tension and stress on the fascia can cause small tears. These tears require a long time to heal because of the poor blood supply to connective tissues such as the plantar fascia. Continued and repetitive activity puts stress on the tendon and slows down the healing process and people can get to a point where they can no longer reduce their activity to allow the slow healing process to take place.

Ultimately, Plantar Fasciitis recovery time is significantly reduced when professional care and treatment from an experienced practitioner is put in place.

If recognised early, pain might be successfully reduced in as little as six weeks. Chronic cases often take three to six months to heal completely, and sometimes longer.

Is Plantar Fasciitis with high arches common?

High arches can be yes, but there are many factors that can associated with plantar fasciitis including:

  • Flat feet or high arches.
  • Tightness in the leg muscles (hamstring or calf) or Achilles tendon.
  • Being on your feet for long periods.
  • Repetitive foot use, such as walking, running & dancing on hard surfaces.
  • Excessive exercise or sudden increase in intensity or duration.
  • Being overweight.

Prevention is better than cure!

There are certain things that you can do to try to prevent/manage plantar fasciitis. These include:

  • Losing weight if you are overweight.
  • Warming-up properly before and after exercise.
  • Regularly stretching the plantar fascia, calf and Achilles tendon, especially before exercise.
  • Avoiding exercising on hard surfaces.

Will Plantar fasciitis go away?

In the majority of cases plantar fasciitis can be cured.

The treatment required depends on the individual e.g. when repeated strain occurs micro-tearing can result, leading to heel and/or arch pain, then to help reverse this process laser treatment can be of great benefit.

Treatment of Plantar fasciitis using low-level laser therapy (LLLT)

Emerging evidence suggests that low-level laser therapy (LLLT) is an effective treatment for plantar fasciitis (PF).

Research has shown pain scores significantly decreased after a course of treatment with LLLT. In addition to this the improvement continued for up to 3 months post treatment.

Source

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370152/

So What is Laser Therapy?

Laser therapy uses light to favour and accelerate the body’s natural healing processes. The laser beam is moved over the skin so that the light energy (photons) penetrates the tissue where it interacts with various molecules (chromophores) that cause different biological effects. It produces a photochemical, photothermal and photomechanical effect.

There are many types of lasers.  Each laser has different characteristics which produce a different effect.  These characteristics include:

  • Energy: measured in joules
  • Time: Defined as the duration of irradiance of target tissue and is measured in seconds. It is also known as Impulse Duration or called “impulse width”.
  • Wavelength: Penetration depth is directed by the laser emission wavelength and the type of tissue (chromophores).
  • Frequency: Defined as the number of impulses emitted during the unit of time (1 second) and should reflect the condition treated.
  • Power: the rate at which energy is delivered and is measured in watts.
  • Fluence: Energy Density or Dose
  • Irradiance (Also known as Power Density): Power delivered per unit area
  • Emission Mode: Continuous Wave (CW) or Pulsed Wave (PW)
  • Impulse Duration: Duration of laser emission, also called “impulse width”.

Clinical Benefits

MLS Laser Therapy is an example of low-level laser therapy (LLLT) that can alleviate both acute and chronic pain. This technology is FDA-cleared and has an 85% – 90% efficacy rate in relieving pain and inflammation, eliminates risk from surgery and prescription pain killers, has no negative side effects.

Contraindication

Low-level laser therapy is painless. The only strict contraindication (reason for not being able to treat is if the patient has active cancer). As LLLT cannot distinguish between healthy and cancerous, it could potentially assist cancerous cells as it assists healthy cells.

Patients who are on anticoagulant medications are permissible for LLLT treatment but the clinician should be informed. This includes medications such as:

  • Warfarin (Coumadin and Jantoven)
  • Rivaroxaban (Xarelto)
  • Dabigatran (Pradaxa)
  • Apixaban (Eliquis)
  • Edoxaban (Lixiana)

In Addition to treating Plantar Fasciitis practitioners also report that MLS Laser Therapy effectively treats pain and inflammation associated with the following conditions:

  • Neuromas
  • Neuropathies
  • Arthritis
  • Sports injuries
  • Tendon & ligament injuries
  • Back & joint pain
  • Muscle sprains & strains
  • Tendonitis
  • Wounds
  • Post-surgical swelling

Morton’s neuroma is a condition caused by an inflamed nerve that causes pain in the ball of the foot. It is a painful sensation which affects the ball of the foot radiating into the third or fourth toe. It can feel as if you are standing on a pebble in your shoe or on a fold in your sock. Morton’s neuroma involves a thickening of the tissues around one of the nerves leading to your toes.

Who can it affect?

  • Females
  • Men

Symptoms:

People who suffer from this condition have symptoms such as pain, burning sensations, nerve-like pain, sharp and electric pains in the ball of the foot radiating into the third and fourth toe. People may also experience stinging sensation or numbness in the affected toes. This pain can worsen with day-to-day activities such as walking, climbing stairs or hills and when doing sports recreational activities.

Why do you get a Morton’s Neuroma:

The top reasons are:

  • Footwear such as high heels and tight toe boxed shoes
  • Genetics / Congenital
  • Sports that are high impact or require tight fitting shoes

Diagnosis

A specialist can diagnose a neuroma several ways:

  • X-Ray
  • MRI
  • Ultrasound
  • Palpation – this entails pressing on your foot to feel for a mass or tender spot. There may also be a feeling of “clicking” between the bones of your foot.

Treatments & Management:

  • Insoles
  • Surgical Intervention
  • Therapy
  • Shock Wave Therapy
  • Laser Therapy
  • Corticosteroids
  • Manipulations/manual therapies

Manual therapies for Morton’s neuroma explained:

Manual therapies are a highly effective option for the treatment of Morton’s neuroma – This can include manual therapies such as foot mobilisations and manipulations.

Mobilisations and manipulations are two non-invasive manual therapies that aim to reduce pain and restore movement into joints and surrounding tissues. They both work within the scale of your natural range of motion (RoM) available at the joints being treated.

Mobilisations use slow rhythmic movements and are performed within the passive range of motion of the joint. Its physiological effects stimulate receptors in the tissues and joint capsules. This sends feedback to the brain, effectively reminding the body of the motion which is available at that joint. Mobilisation is particularly useful as a treatment method in conditions such as Morton’s neuroma, injuries such as plantar fasciopathy and Achilles tendinopathy, during rehabilitation including high trauma, and ankle injuries.

Manipulation involves applying a specific amount of force in a very precise motion to a joint, to reduce joint restriction and restore normal range of motion. Manipulation has been shown to increase blood-flow to the affected area. Manipulation also immediately improves the mobility of the joints and reduces the pain experienced in the surrounding soft tissues. Some injuries result in adhesions and cross linkages forming around a joint limiting its movement. Manipulation can release the joint from these hindrances and return normal, smooth motion to the previously injured structure.

Manipulation has been shown to offer a better long-term result than a steroid injection.  As a non-invasive treatment it is therefore one of the best options for treatment of a Morton’s neuroma, and why we use this approach extensively in The Foot & Ankle Clinic in Darlington.

  • Laser treatment for Morton’s neuroma (which is the same thing as laser therapy for Morton’s neuroma), can be extremely effective, especially when used alongside other treatment modalities. We are fortunate in clinic to have all the leading technologies such as laser, focal shockwave and radial shockwave so allowing us to combine their use as required with patients.
  • SIS and Focal shockwave therapy for Morton’s neuroma are also extremely useful, and we use them alongside manual therapies in the clinic, but this is a discussion for another blog…

If you are suffering with foot pain caused by a neuroma or any other issue please go to our foot pain page on our website to see how we can help you https://thefootandankle.clinic/pain/foot-pain/