What on earth is shockwave and why will it help my plantar fasciitis?

The word 'shockwave' sounds more like a '90s music festival than a medical treatment, but it can be an effective method to reduce pain for certain conditions.

How does it work?

Excellent question. No one knows for sure but there are a number of leading theories. Shockwave is not actually a shockwave but is an acoustic wave (sound). This acoustic wave can help tissue growth and increase blood flow, which can be important for chronic conditions. It can also reduce pain by changing neurotransmitters that are responsible for sending signals to the brain.

Is it safe?

Yes shockwave is a very safe treatment for most people. If you are pregnant, have a blood clotting disorder, a metal implant, or for children, shockwave is not a treatment option.

What does it feel like?

For this treatment a wave or pulse will be delivered approximately 2000 times. You will feel a slight 'hit' on the part that is being treated. I find that people often report different sensations. Some people think it feels amazing, like a massage. Other people report some discomfort that feels like an electric shock.

What conditions can shockwave be used to treat?

Shockwave is excellent for tendon and fascia conditions. In the foot and ankle, these will include Achillies tendonitis and plantar fasciitis. There is good evidence that supports the use of shockwave to treat these conditions.

More information

The podiatrists at Fitzroy Foot and Ankle Clinic have been using shockwave for several years and have treated hundreds of patients. It is a very effective treatment for plantar fasciitis and Achilles tendonitis, as part of an overall treatment plan.

Make an appointment with one of our podiatrists if you would like to chat about shockwave, or follow this link to our page to find out more about shockwave.

5 tips for avoiding plantar fasciitis

There are many forums and blogs that discuss plantar fasciitis and its treatment. What we don't really understand is what causes plantar fasciitis, however we do have a good idea about the main risk factors for getting plantar fasciitis.

1. Keep your weight down

This is easier said than done, however one possible causes of plantar fasciitis is compression of the plantar fascia under the heel bone. If there is too much weight coming from above the plantar fascia can get overloaded and the tissue will break down. Often people with plantar fasciitis will report recently gaining weight, and the plantar fascia does not have the capacity to deal with this increase in weight. People who have a high BMI are more likely to experience plantar fasciitis, and in most randomised trials for plantar fasciitis, the mean BMI is 30 kg/m2 (which is classified as obese).

2. Stretch your calves

Decreased ankle joint range of motion is another important risk factor for plantar fasciitis. When we walk our body needs to move over the foot, however if there is insufficient motion at the ankle, the motion will be found at the next joint. This will lead to flattening of the arch and increased stress being placed on the plantar fascia. So maintaining good ankle joint range of motion by having flexible calves is an important method of preventing plantar fasciitis, and other type of foot pain.

3. Avoid flat shoes

Plantar fasciitis is more common in warmer weather when people are walking around barefoot or in flat sandals or thongs. When standing barefoot, there is increased tension placed on the plantar fascia, plus the body's centre of pressure is located toward the heel. When wearing shoes with a heel lift the tension on the plantar fascia reduces, and the centre of pressure moves toward the toes.

4. Avoid standing for long periods

Another big risk factor for plantar fasciitis is the number of hours spent standing. People who have jobs requiring long periods of standing on hard floors (e.g. nurses, teachers, chefs) tend to experience plantar fasciitis more often. Rather than quit your job and work in an office, trying to break up long periods of standing may help to reduce the chance of getting plantar fasciitis.

5. Modify long distance running

Any respectable running blog or forum will be plastered with posts about plantar fasciitis, because it is common in those who run long distances. Similar to those who have high a BMI, there is either a repetitive compression of the plantar fascia into the heel bone or an excessive pulling of the plantar fascia where it inserts on the heel bone, or both are happening at the same time. If you are prone to experiencing plantar fasciitis, and can't deal with the pain, modifying your running may make a difference. This may involve reducing the number of sessions per week or the distance you run.

What is plantar fasciitis . . .

Plantar fasciitis is a pathology that affects the plantar fascia. Your plantar fascia is a structure, similar to a ligament, that attaches on the bottom the the heel and connects under the forefoot. Commonly, people will experience pain where the plantar fascia inserts onto the bottom of the heel bone, which is the called the calcaneus. The plantar fascia is primarily responsible for assisting propulsion when walking and running.

People with plantar fasciitis will report symptoms such as sharp or stabbing pain, especially when standing after a period of rest. This pain may return at the end of the day, but may feel more achey and dull rather than sharp with the first steps after standing. This is a common presentation of plantar fasciitis, however people may have plantar fasciitis but experience different symptoms. When exercising, plantar fasciitis tends to warm up and then feel less painful. If you have a pain that is constantly increasing with activity, it might be a different pathology.

Plantar fasciitis is a common condition in the community, with a prevalence of approximately 10%. It tends to be most prevalent in people aged 40-60 and in athletes. It may occur in one foot or both feet at the same time. The main factors associated with plantar fasciitis include high BMI, increased time spent standing and a restricted ankle joint range of motion.

Often people will have a bony growth on the bottom of the calcaneus that is commonly referred to as 'heel spurs'. People with heel spurs are 8 times more likely to experience plantar fasciitis (McMillan 2009), however not all people with heel spurs will have pain.

Finally, plantar fasciitis is referred to as a 'self-limiting' condition, which means that it will go away eventually. However, in the time that it is painful it can have a significant effect on quality of life (Irving 2008), and can increase depression, anxiety and stress symptoms (Cotchett 2016). Therefore, it is important to effectively reduce pain to prevent these reductions in quality of life.

References

McMillan, A. M., Landorf, K. B., Barrett, J. T., Menz, H. B., & Bird, A. R. (2009). Diagnostic imaging for chronic plantar heel pain: A systematic review and meta-analysis. Journal of Foot and Ankle Research, 2(32). Journal Article. http://doi.org/http://dx.doi.org/10.1186/1757-1146-2-32

Irving, D. B., Cook, J. L., Young, M. A., & Menz, H. B. (2008). Impact of chronic plantar heel pain on health-related quality of life. Journal of the American Podiatric Medical Association, 98(4), 283–289. Journal Article. http://doi.org/http://dx.doi.org/10.7547/0980283

Cotchett, M., Munteanu, S. E., & Landorf, K. B. (2016). Depression, anxiety, and stress in people with and without plantar heel pain. Foot & Ankle International, 37(8), 816–21. http://doi.org/10.1177/1071100716646630

What can I do about plantar fasciitis?

There are a number of conditions that cause pain on the bottom of your heel. The most common cause is plantar fasciitis, which affects approximately 1 in 10 people.

The plantar fascia is a ligament-like structure that runs from the bottom of the heel to the ball of the foot, and helps to support the arch.

Plantar fasciitis is characterised by a sharp pain when first getting out of bed in the morning, which reduces with walking. However, the pain may return at the end of the day, and be just as painful as the morning pain.

Risk factors for plantar fasciitis include being overweight, increased time spent standing and a decreased ankle joint range of motion. These risk factors all place extra stress on the plantar heel, resulting in pain. Therefore, addressing these risks are a key part of successful management.

There are a variety of treatments that podiatrists use for plantar fasciitis, however there is no agreement on which treatment is the most effective.

Plantar fasciitis self-care treatments include:

• reducing weight (ideally a BMI below 30);

• reducing activity levels (e.g. amount of running) or time spent standing;

• wearing supportive cushioned footwear (e.g. runners);

• performing calf and plantar fascia stretches before standing after a period of rest.

If these treatments fail, there are a variety more complex treatment options, which can be provided by the podiatrists at Fitzroy Foot and Ankle Clinic. Two commonly provided treatments are foot orthotics and extracorporeal shockwave therapy. A number of clinical trials have demonstrated that these treatment options are effective for reducing plantar fasciitis. Given that a combination of treatments is likely to result in an optimal outcome, it is important to have a treatment plan tailored to you as an individual.