New Treatment for Chronic Heel Pain in Plantar Fasciitis

Ye.V. Ryabko, Ye.V. Bakhtereva, S.L. Zuev 
Energy For Health [22], 2022

Plantar fasciitis is a painful condition of the foot. It is defined as an inflammation of the plantar fascia, the fibrous envelope of the tendon that forms the arch of the foot (from the Latin "fascia"). The role of the plantar fascia is to support and protect the tendon on the sole of the foot.
Plantar fasciitis is one of the most common causes involving pain at the base of the heel. In the course of life, it affects up to 10% of the population.
It usually lasts for at least 6 months, rarely reaching a year. The clinical course for most patients is positive, about 80% report a resolution of symptoms within 12 months. [Martin RL et al.]
Plantar fasciitis mostly affects the population between 40 and 60 years of age, the women and obese subjects.
Plantar fasciitis mostly affects the women, obese subjects, athletes – especially runners and population between 40 and 60 years of age.
Among musculoskeletal injuries related to running, the incidence of plantar fasciitis varies between 4.5% and 10%, with a prevalence between 5.2% and 17.5%. [Lopes AD et al.]. Sudden increase in mileage out of proportion to training, incorrect running posture, wrong choice of running shoes, running on too hard ground, are all possible causes of plantar fasciitis development. 
The precise mechanism of onset of plantar fasciitis is still being studied, as the research conducted so far reports conflicting data. Experts agree in considering this condition as the result of excessive stress on the plantar fascia which, if subjected to repeated stress and microtrauma over time, degenerates and becomes painful.
The diagnosis of plantar fasciitis can be made through the only physical examination; however, medical doctors (in alternative physicians) may also order imaging studies to clear up any doubts and to rule out other possible causes of heel pain.
Plantar fasciitis takes several months (6 to 12) for complete recovery from pain symptoms that, interfering with daily routine, could impair life quality. 
Among the therapies planned to solve this condition, there are: the pharmacological approach, aimed at affecting the symptoms of plantar fasciitis by administering non-steroidal anti-inflammatory drugs and corticosteroids; the "strengthening" approach with stretching and strengthening exercises and the use of specialized devices (splints, orthotics); the surgical approach and therapies based on the use of physical agents like extracorporeal shockwaves therapy (ESWT) and laser therapy.
Shock waves are pulsed acoustic waves that dissipate mechanical energy at the interface of two substances with different acoustic impedance. Such therapy has demonstrated good results in the treatment of patient affected by plantar fasciitis [Li et al.] but it is not free of collateral effects.
Roerdink et al. in their systematic-review on the complication of ESWT in plantar fasciitis, found that the 11.6% of the patients reported pain during the treatment. Dysesthesia, swelling, ecchymosis and/or petechiae, severe headache, bruising, throbbing sensation and temporary pain after treatment, <1 week from the treatment session end, were also been noticed.
Laser therapy has been demonstrated to provide many beneficial effects through photochemical, photothermal and photomechanical interaction with the tissue. 
Low-level laser therapy (LLLT) by class 3B lasers with Power <500 mW, in a recent systematic review [Guimarães et al.] demonstrated to be effective in the treatment of plantar fasciitis, reducing pain of 2.2 on a 0–10 pain scale and providing an average improvement in pain of 40%. Moreover, compared to extracorporeal shock wave therapy, LLLT resulted equivalent in reducing pain intensity in the short term.
In the last years High-intensity laser therapy (HILT) by class 4 laser source with power > 500 mW, has gained importance in the treatment of musculoskeletal disorders and sports injuries [Brown et al., Dundar et al.]. HILT has been recognized to be a safe, non-invasive and non-painful therapy.
Clinical evidence on the effects of HILT in combination with other physical therapies are limited despite treating patients with several therapies during the same treatment session and/or in succession, is becoming part of common practice.
Akkurt et al. evaluated the effects of HILT in combination with insole versus insole alone, in patients affected by chronic plantar fasciitis and found that the combined therapy was more effective than the sole insole in terms of pain and quality of life.
The purpose of this study was to evaluate the performance of ESWT, HILT and their combination, in patients with chronic heel pain, caused by plantar fasciitis, in terms of pain relief. 
We hypothesize that the use of ESWT and HILT combined together in succession, during the same session treatment, could act synergically and lead more benefits in terms of: less invasiveness and pain symptoms after the treatment and higher antalgic, anti-inflammatory, anti-oedema, reparative and regenerative effects on deep structure.