Do Medical, Surgical, and Physical Therapy Treatments Work for Plantar Fasciitis?

A systematic review of the comparative effectiveness of treatment options for plantar heel pain that involved thousands of patients concluded available evidence does not suggest that any The commonly used treatments for the prevention of plantar heel pain are better than any other. It's hard for any treatment to beat out control groups, since placebos can result in a clinically significant two-point drop in pain, a 0 to 10 pain scale, that increased to about a three-point drop in 12 months. Increasing improvement over time is uncharacteristic of the placebo effect, so the pain relief may be more likely due to factors like regression to the mean, Or simply the power of the tincture of time on a self-limiting... Surgery is considered only as a last resort. Does surgery beat out non-surgical options? The evidence is mixed, but there have not yet been any sham surgery trials to see if any surgical procedures beat out placebo. Steroid injections are commonly used to treat plantar fasciitis, and they have been studied in placebo-controlled trials. And steroid injections were found to offer little or no pain relief, even in the short term, and can cause rare but crippling complications. These include nerve injuries, bone infections, and, months later, Plantar fat pad atrophy, and maybe not so rare after all. Steroid injections may cause plantar fascial rupture in as many as 1 in 10 individuals approximately 10 weeks after injection. Why, then, do doctors continue to administer them? Health professionals often see with their own eyes that their injected patients experience relief without understanding that they would have likely experienced about the same relief without undergoing any treatment at all. They trust their experience over the evidence. If doctors want to inject something into patients to feel useful, why not inject a placebo instead of a steroid? At least a placebo won't rupture anyone's foot, ironically. It's not considered ethical to inject a placebo, but it's apparently okay to inject something that can do more harm than good. One compromise is injecting the patient's own blood, or blood concentrate, back into their foot, which, according to the best evidence, works no better than placebo, but can be administered under the deceptive guise of treatment. There are two injections for plantar fasciitis that may actually beat out a placebo, Sugar and Botox. Prolo therapy is the injection of an irritating substance, like a concentrated sugar solution, to purposefully cause tissue damage in the hopes of revving up the body's own healing process. Such injections appear to beat out saline placebo injections for plantar fasciitis for pain relief and improvement of function. Likewise, the reduction in muscle strength From injecting Botox can decrease tendon tension and relieve plantar fasciitis pain compared to a placebo at one month follow-up, but makes no significant difference at months 3, 6, or 12. What if you just stick needles into the body without injecting anything? Both dry needling and acupuncture appear to be effective compared to no needle controls, but there's only been one placebo-controlled trial performed for each. Compared to sham dry needling and sham acupuncture, no clinically significant benefit. What about manual physical therapy, such as joint and soft tissue mobilization and manipulation? Only one of six studies found that manual physical therapy resulted in a clinically significant decrease in pain. What about some of the commonly used PT devices, like therapeutic ultrasound? Looks like there's only been two placebo-controlled studies thus far of therapeutic ultrasound for plantar fasciitis, and compared to sham ultrasound, No significant improvement was found in any of the measured outcomes. What about higher energy sound waves, extracorporeal shock wave therapy? Shockwave therapy has been used to disintegrate kidney and bile stones for 50 years using high energy pulses of sound waves. It's considered one of the most promising treatments for plantar fasciitis. Though the mechanism by which it could offer therapeutic benefit is unclear, Oh, here. the problem is it's difficult to come up with a convincing fake to compare it against. Even in a trial that used a nerve block to numb the foot, The real shockwave therapy caused pain in the vast majority of study participants, though it's no surprise that most people in the active treatment group accurately guessed which group they had been randomized to. Though the trial reported positive results, it's hard to know what role the placebo effect played. Perhaps the most convincing placebo-controlled trial involved not only the use of local anesthesia, but also a specially designed air-filled cushion to reflect the shockwave. With a truly indistinguishable placebo, no benefit to real shockwave therapy was found. The researchers concluded that extracorporeal shockwave therapy is ineffective in the treatment of chronic plantar fasciitis in some trials. Even when patients could tell which group they were in, shockwave therapy still flopped. A systematic review and meta-analysis of all such studies found that pain relief with shockwave therapy failed to achieve clinical significance. What's more, the higher quality trials didn't even detect a statistically significant effect. And remember, this was supposedly the most effective active treatment. At least shockwave therapy is considered safe, with reports mostly of pain during treatment and transient skin redness. What about using light waves instead? A meta-analysis of red-to-infrared lasers and laser diodes for plantar fasciitis found no significant benefit for pain overall. Is there anything that works? Yes, self-care measures like stretching, which I'll cover next.