How I Treat Plantar Fasciitis and Heel Pain.

My Protocol for Plantar Pain and Heel Pain   MY UNDERSTANDING OF PLANTAR PAIN AND ITS PATHOPHYSIOLOGY  There are four causes will causing heel pain: (1) Inflammation of fatty pad. (2) Strained tendon and Tendonitis. (3) Osteological spurs. (4) Bursitis. For each of the above problems I have a similar protocol however for each of the above problems the there can be varied degrees of response to this treatment. The reason I have the same protocol is I do not address any of those problems directly I go for the main cause. The main cause to me is what is stopping the body from resolving the above four problems.  In my opinion the main cause is muscle pain and tightness which blocks the body from being able to heal itself of these four problems. All of these four areas get very little direct circulation.  If the trickle of vascular support to these areas is compromised in the slightest it results in the wear and tear of daily walking and standing becoming injurious. The body when resting at night cannot keep up to the strain of the day.  If you however are able to increase the circulation to these areas even for a short time you can make up for years of wear and tear. It took years to create the problem but a massive increase in blood and nutrients to an area and a continued good circulation can work miracles or what seems like anyway.  In my approach I address specifically the circulation and muscles. A tight muscle will not allow for a free flow of blood and fluids through or around it. However, once the area is supple and relaxed then lymphatic drainage and blood oxygenation and nutrients can flow to help an area renew itself. This will result in a reduction in pain as well as inflammation. The area will feel stronger and all connected areas will also feel better.  The body knows how to heal humans have had these problems since the beginning and a human that cannot walk does not eat. So with this simple logic let us trust aid the body circulation and it will fix its own problems we still cannot fathom the amazing healing abilities of our bodies.   MY TREATMENT TECHNIQUE In the initial treatment of Plantar Pain I use gentle approach with TCM acupunture protocol along with electro stimulation. This usually uses balancing points like P7 on the wrist or other ashi or tender points around the wrist or elbow area. Also ear seeds on the heel area of the ear are also used. The electrostimulation is usually in the local area of pain or up in the calf area on motor points relating to the muscles that connect to the achilles or plantar ligaments and tendons.  This is usually followed by a mild massage with instructions to soak the feet in a detox bath. The self massage is shown to be most important and it should be painful to a point to get results. The theory is that if there is pain there is a blockage to remove the blockage acupuncture is used around the wrist. This tells the body to adjust the circulation around the heel and foot. When the circulation increases then healing occurs and the body starts to catch up on the viscous circle of inflammation and pain. The ear points have been found to influence the brain and how it interprets pain as well as change circulation patterns in various areas in the body to aid healing in areas of chronic inflammation and pain. This first protocol is not always effective but it is gentle and comfortable for the client and along with other interventions have been found to be very effective.  Should the client be comfortable with trigger point therapy and has been using a ball to massage the feet calf and gluteal areas and still has not found adequate relief then more direct approaches are used.  Dry needling or wet needling with procaine 1% and Hydroxal Cobalamin (B12) in a 2cc/1cc repsective syringe.  This protocol can sometimes be used earlier if the client is interested and understands the medical theory behind trigger point injection. Also it is generally more effective to use trigger point injection and will lead to a faster recovery. If time is an issue then the added risk and expense with some discomfort can be a factor to move to trigger point injection before the above TCM procedure.   If there are allergy issues then a dry needle approach would be used however the wet needle is generally more comfortable due to the procaine also there is a more lasting effect on the muscles as a result.  The main muscles to be needled are the Soleus, Quadratus Plantae, The Flexor Digitorum Brevis, and ABd Hallucis depending on tenderness on palpation.  Other muscles assessed for tenderness due to thier supporting function will be Gastroc, Flexor Digitorum Longus, Flexor Hallucis Longus, peroneus longus; peroneus brevis); tibialis anterior; extensor hallucis longus; extensor digitorum longus Loading muscles like gluteus maximus; gluteus medius and gluteus minimus are almost always included since they are major drivers so to speak for the lower body. These major muscles are large in size and will effect the whole body if they are tight or problematic with trigger points. When needling the gluteal area I usually clear the whole area and it does not take very long and is one of the safest and most comfortable area to have needled in this way. Other lesser loading muscles can be the piriformis, tensor fascia latae on the side of the leg; adductor longus; adductor magnus; adductor brevis, semitendinosis; semimembranosis and biceps femoris. These would be assessed later unless they are reported by the client as tender or part of a pain pattern that recognizes these muscles. When I needle a muscle Trigger Point the response looked for is a twitch or a dull ache or heavyness or a reproduction of the pain. After the needling the pain should have subsided. The needle is used to find and release tight stuck muscle tissue. The amount of work done on a particular treatment will depend on the clients comfort and tolerance. Ususually only around 5 or so of the above muscles will be needled in a treatment.   Bruising and discomfort or heavyness for up to 12 hours after treatment and sometimes as long as a week can occur.  A series of 6 treatments should be enough to resolve even difficult cases.  If however the pain still in not resolved then tendon attachments will be assessed for tenderness. If these are tender and relate to the pain then it is assumed there is some tendon weakness or damage leading to the muscle trigger points being activated despite being released previously.  In this case then dextrose can be introduced to induce the regrowth of the tendon. This can profoundly improve the muscle function and thus reduce the pain in the area.  If there is still slow progress then Herbal medicine can be used to increase the circulation and strengthen the bodies resources to help heal and calm the pain in the foot. Other complications can be disease, smoking and poor diet or emotional health. Usually one will see a direct change in the first treatment it is usually just a matter of seeing how long it lasts. Sometimes one or two treatments are enough along with other interventions and self care. If not then we need to add other components to support the body in its imbalance.  Herbal patent remedies for heel and foot pain can include  Dang Gui Di Huang Yin Wan, (Tangkuei and Rehmannia Decoction) for KIdney and Liver Yin deficiency where you can see circulation is poor and problem is chronic. In a more acute healthy person I would recomend TCM along with Myofacial Trigger point theory make for a powerful combination for any pain problem. In this case of plantar pain we also have orthotics as well as a wealth of physiotherapy information one can draw upon to prevent the recurrance of this debilitating pain.  I hope this is helpful for clients and practitioners alike. I have found this approach to be effective and I encourage more to use this protocol. I want to reference the study I drew from to develop part of this treatment. www.jfootankleres.com/content/4/1/5/table/T1