Dr. Eric Pack Explains, "New bioactive healing products for tissue regeneration can speed relief of plantar fasciitis pain. Optimal results depend on accurate diagnosis of pain etiology and addressing restoration of normal foot function. If your plantar fascia pain has lasted longer than eight weeks, ask yourself these 7 questions. The answers could uncover problems with your treatment."
7 Questions to Ask About Your Plantar Fasciitis Treatment
1. Has micronized injectable amniotic allograft been evaluated as a treatment option for chronic inflammation?
In the past, when conservative plantar fasciitis treatment (custom orthotics, topical compound anti-inflammatory creams, oral anti-inflammatory medications, oral steroids, corticosteroid injections, physical therapy) had been exhausted with no foot pain relief, surgical intervention was the only option.
Today, the field of regenerative medicine offers bioactive healing products for tissue regeneration that can prevent prolonged and painful recovery periods to restore mobility.
One of these products getting good results is EpiFix, a micronized injectable amniotic allograft developed by MiMedx. MiMedx has developed an advanced technology they call the Purion Process that sterilizes, and micronizes donated human amniotic membrane tissue.
EipFix injectable amnion allograft contains collagen matrix, growth factors and cytokines that effectively reduce inflammation, reduce scar tissue formation and enhance healing of micro-tears in soft tissue. It comes in a powder micronized form and is reconstituted at the time of treatment with sterile saline.
The procedure is performed in the office setting using ultrasound or fluoroscopy guided injection in and around the area of damaged plantar fascia ligament.
When used for the treatment of chronic plantar fasciitis the result is resolved soft tissue thickening of the plantar fascia ligament, decreased soft tissue pain and increased flexibility. The result is improved mobility for the patient during physical activity whether it be for recreation, sport or working.
Based on patient clinical outcomes of pain management and restored mobility over a twelve month period I consider EpiFix injection a viable and long-term treatment option for my patients going forward.
The majority of patients treated with EpiFix self-report a noticeable decrease in pain within four weeks. But don't wait too long to seek treatment. Once damage to the plantar fascia ligament becomes too great (with risk of rupture) or the bone spur becomes too big, surgery may be the only option left.
2. Do you know your foot type and are you certain that you are using the proper arch support to restore healthy foot function?
Bioactive healing treatment provides relief long-term only if the underlying causes for the plantar fascia damage are properly identified and resolved, otherwise plantar fascia injury will continue.
Plantar fasciitis arch pain and heel pain develop when the plantar fascia of your foot (the fibrous band of connective tissue that extends from your heel to your toes) becomes inflamed.
The plantar fascia becomes inflamed when,
- its stretched beyond capacity because the foot isn't getting the proper arch support, or
- more pressure is placed on the arch than it is built to bear due to overuse or obesity.
Once micro tears occur in the plantar fascia, and the abnormal pressure on this ligament continues, it won't heal on its own and further complications develop.
3. Has x-ray shown diagnosis of heel spur?
Left untreated plantar fasciitis creates a bony growth, or heel spur, due to the excessive tension at the insertion point of the plantar fascia on the underside of your heel bone. Heel spur pain is caused by the plantar fascia ligament pulling excessively on the heel spur due to inadequate arch support.
4. Have you been diagnosed with Baxter's nerve entrapment?
Untreated plantar fasciitis can also cause entrapment of the medial and lateral plantar nerves and, or Baxter's nerve. Baxter's nerve entrapment occurs when the plantar fascia becomes thickened from continued inflammation and compresses the nerve. Neurological symptoms of Baxter's nerve entrapment include electrical tingling, burning, shooting, radiating type pain from the heel into the arch.
5. Have you been diagnosed with medial or lateral plantar nerve entrapment?
Continued, uncorrected excessive pronation causes the deep myofascial band of the abductor hallucis muscle to become tight up against the calcaneous bone (heel bone) and subsequently, the medial and lateral plantar nerves become compressed and painful.
6. Have all potential causes of continuing plantar fascia pain been investigated and addressed?
The above sequence of progressive conditions associated with untreated plantar fasciitis or the misdiagnosis of any one of these three conditions can be the cause of chronic arch or heel pain.
Once pain and inflammation have resolved conservative treatment modalities, particularly custom made orthotics and stretching exercises, are more effective with maintaining proper foot biomechanics and arch support for long term resolution of your foot pain.
7. If all footwear you use do not offer arch support needed to offload stress on your damaged plantar fascia, are you wearing orthotics for your foot type that can be used interchangeably in most footwear?
Patients with prescribed protocol of conservative treatment combined with injectable amnion allograft have reported they are pleased with results, singularly avoiding surgical intervention. Successful long-term outcomes for these patients were dependent on a thorough diagnostic workup and strong compliance with utilizing proper arch support for their foot type, avoiding re-injury of the plantar fascia ligament.