Houston Methodist. Leading Medicine

Foot FAQ

Question:

Have you heard of laser treatment for plantar fasciitis? Does it work?

Answer:

The standard treatment for plantar fasciitis includes actively stretching the gastrocnemius and soleus (calf) muscles and passively stretching the plantar fascia (connective tissue along the bottom of the foot). Other conservative measures often used include medications and steroid injections. There is limited evidence that steroid injections really do more than mask the pain for a short period of time. Shockwave therapy has also been studied in the treatment of heel pain associated with this condition. But the studies have come up with conflicting evidence (some say there were good results, others report no significant improvement). Low-intensity laser (light) therapy has no supporting evidence despite the fact that those who use laser as a modality swear by it. More studies are really needed to research this further. Different intensities and duration of laser might make a difference. Combining laser with other treatments (stretching, manual therapy) might be more effective. We do know that the stretching helps but doesn't always completely alleviate the problem. In a recent study, physical therapists from Brazil compared the use of stretching alone with a program of manual therapy combined with stretching. In this instance, manual therapy refers to the release of trigger points in the calf. This technique was done by placing the therapist's hands directly over the calf muscles and applying pressure and then light stroking of the soft tissues. Trigger points are irritable areas in the muscle. The area becomes tight and stiff keeping the muscle from moving (and stretching) normally. It's that stiffness that these researchers thought might respond better to manual therapy along with stretching. In theory, until the trigger point has been released, the heel pain will continue (or come back as soon as the stretching stops). The technique was very successful. Results showed greater improvement in all measures for the manual therapy plus stretching group compared with the stretching alone treatment group. Patients in both groups got better but the manual therapy group had statistically significant improvements over the stretching only group. The exact mechanism by which this works isn't known. It could be that trigger point therapy as described here decreases pressure pain sensitivity. Perhaps it turns off a reflex that is triggering muscle tightness so that the stretching becomes more effective. More study is needed in the area of treatment for plantar fasciitis. Laser therapy may eventually prove useful but for now, stretching and manual therapy seem to get the best results. Additional study is recommended to see if there are better ways of doing the manual therapy that might be more effective. This could include comparing Swedish massage, friction massage, myofascial release, acupressure, and other similar techniques with the manual therapy described in this study. Since we don't know if other types of touch (just placing the hands over the tissue) might also work well, this might be another technique included in the comparisons. And, of course, laser combined with stretching or laser combined with manual therapy might produce good results. We won't know until it's tested! Rômulo Renan-Ordine, PT, DO, et al. Effectiveness of Myofascial Trigger Point Manual Therapy Combined with a Self-Stretching Protocol for the Management of Plantar Heel Pain: A Randomized Controlled Trial. In Journal of Orthopaedic & Sports Physical Therapy. February 2011. Vol. 41. No. 2. Pp.43-51.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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