Treating Plantar Fasciitis Conservatively: Evidence-Based Case Report

Abstract

(Figure 1). Her treatment program included ultrasound at 1.5 watts/cm 2 for 4 minutes, icing, gentle stretches to Achilles tendon for 10 times, intrinsic muscle strengthening and home exercises. Home exercises included myofascial release with tennis ball and tin, standing stretches to triceps surae and strengthening of intrinsic foot muscles on towel. After 2 weeks, she reported no significant improvement and her treatment plan were modified. After reviewing the literature, there was addition of iontophoresis with acetic acid, taping, stretching of the plantar fascia, and manual therapy of myofascial chains and use of heel pads. Emphasis was placed on manual therapy involving myofascial release and friction massage. Icing was replaced with heating modality. After 2 weeks, she had much improvement and her pain intensity was 3 on VAS. She was advised to take vitamin C (1-3 g/day) and glucosamine sulphate (500mg for thrice/day). Same treatment was continued for 2 more weeks and the patient was assessed for complaint of pain, the VAS score at this stage was 0. Duration of each treatment session lasted for 40 minutes. Patient was educated for preventing the recurrence of the problem and was emphasized to continue home exercises for further 2 weeks. Discussion In this paper, I have mentioned a case of plantar fasciitis typically affecting a middle aged sedentary woman with history of prolonged standing during household activities. Not only this but also keeping in mind, she had history of high heel use during social gatherings. However, plantar fasciitis can occur at any age but it commonly affects middle aged women [2,3,5]. Obesity is present in 90% of women with plantar fasciitis [3]. Dawson et al reported 83% prevalence of foot problem in women older than 50 years who wear high-heeled shoes [10]. Mrs. SM presented typical picture of plantar fasciitis concerning to her pain presentation. The exact etiology for this condition is undetermined but the risk factors have been discussed in many studies including intrinsic and extrinsic factors [5,6]. A study by Caroline et al. demonstrated increased pressure on central and medial forefoot and big-toe in those wearing high-heels [10]. There are many treatment options for this condition with varying results but there is no strong evidence supporting effectiveness of any single option [2]. The treatment regimen we used during first 2 weeks proved ineffective while modified treatment plan nullified the patient symptoms. Wolgin et al. [6] reported pain relief in 25% patients with rest treatment. Stretching and strengthening hampered the disease and pain symptoms in this study. Similarly, 83% patients in a study got pain relief through stretching and 35% patients in a study by Martin et al. reported decline in their pain intensity with strengthening exercises [6]. Gentle and sustained stretches were recommended in a study with 10 repetitions for 5-6 times a day [3]. Mechanism by which iontophoresis with acetic acid relieves pain symptoms of chronic heel pain was described in a previous study [4]. Manual therapy was emphasized in case of Mrs. SM and a study by Renan-Ordine et al. [11] supports its effectiveness in plantar fasciitis.