Artritis

Plantar Fasciitis

Plantar Fasciitis:
Diagnosis and Therapeutic Considerations
Mario Roxas, ND

Abstract
Plantar fasciitis is the most common cause
of inferior heel pain. The pain and discomfort
associated with this condition can have a
dramatic impact on physical mobility. The etiology
of this condition is not clearly understood and
is probably multi-factorial in nature. Weightgain, occupation-related activity, anatomical
variations, poor biomechanics, overexertion,
and inadequate footwear are contributing
factors. Although plantar fasciitis is generally
regarded as a self-limited condition, it can
take months to years to resolve, presenting a
challenge for clinicians. Many treatment options
are available that demonstrate variable levels of
efficacy. Conservativetherapies include rest and
avoidance of potentially aggravating activities,
stretching and strengthening exercises, orthotics,
arch supports, and night splinting. Other
considerations include use of anti-inflammatory
agents, ultrasonic Shockwave therapy, and, in the
most extreme cases, surgery. This article reviews
plantar fasciitis, presents the most effective
treatment options currentlyavailable, and
proposes nutritional considerations that may be
beneficial in the management of this condition.
(Altern Med Rev 2005;10{2):83-93)

Introduction
Description
Plantar fasciitis (PF) is a degenerative syndn)me of the plantar fascia resulting from repeated
trauma at its origin on the calcaneus.' PF is reported
to be the most common cause of inferior heel pain in
adults.- Othernames for PF include painful heel syndrome, heel spur syndrome.^ runner's heel, subcalcaneal pain, calcaneodynia. and calcancal periostitis.^

The word "fasciitis" assumes inflammation is an inherent component of this condition. However, recent
research suggests that some presentations of PF manifest non-inflammatory, degenerative processes and
should more aptly be termed "plantarfasciosis.""'•'' In
the United States, more than two million individuals are treated for PF on an annual basis, accounting
for 11-15 percent of professional visits related to foot
pain." It is estimated that 10 percent ofthe U.S. population will experience plantar heel pain during the
course of a lifetime.^ PF affects individuals regardless of sex. age. ethnicity, or activity level. It is seen
in physicallyactive individuals such as runners and
military personnel, but is also prevalent in the general
population, particularly in women ages 40-60.-^''

Etiology and Pathophysiology
The plantar fascia is a thickened fibrous sheet
of connective tissue that originates from the medial
tubercle on the undersurface ofthe calcaneus and fans
out. attaching to the plantar plates of themetatarsophalangeal joints to form the medial longitudinal arch
of the foot. It provides key functions during running
and walking. In general, the purpose of the plantar
fascia is twofold - to provide support ofthe longitudinal arch and to serve as a dynamic shock absorber
for the foot and entire leg.
As one walks, the heel makes contact with
the ground. Just after this contact, the tibia turns inward andthe foot pronates. stretching the plantar
fascia and tlattening the arch. This allows the foot to
accommodate for irregularities in the walking surface

Mario Roxas, ND - Technical Advisor. Thome Research; Associate Editor,
Alternative Medicine Review. Private practice, Beaverton, OR.
Correspondence Address: 11385 SW Scholis Ferry Rd., Beaverton OR 97008
Email: m.roxas@comcast.netAlternative Medicine Review • Volume 10, Number 2 • 2005

Page 83

Plantar Fasciitis
Figure 1. Micro-tears Lead to a Chronic
Inflammatory Response

that exceeds the body's ability to recover." When PF
occurs in elderly adults, it is often attributable to poor
intrinsic muscle strength and poor force attenuation,
secondary to acquired pes planus (excessive pronation ofthe foot) and...