We'll first talk about what plantar fasciitis is, then we'll discuss how to figure out if that is what you're dealing with. Then we'll talk about a review on laser therapy to treat plantar fasciitis pain, how that works, and what the treatment process looks like.
Plantar fasciitis is an inflammatory disorder of the plantar fascia. The plantar fascia is a big, thick band of tissue that runs along the bottom of your foot. You've got one on both feet. What can happen is that can get irritated or stressed or strained somehow and become inflamed. Because of the way that structure is built, it tends to trap inflammatory fluid underneath it.
Once that gets inflamed, what you'll notice is sharp, pretty intense pain on the bottom of the foot, especially when you step down onto it. And that is how we start to get into the diagnosis of this disorder. The classic symptom for plantar fasciitis is this: The first few steps in the morning become exquisitely painful on the bottom of the heel. Also, if you sit for a while or you've driven for a long time and you go to get out, those first few steps are really painful. After you've taken a few steps, it starts to get less painful. In many cases, once you're up and moving throughout the day, it's minimally painful or even not painful at all.
Another way to tell if plantar fasciitis is the right diagnosis is to squeeze each side of the heel (not right on the bottom of the heel, but on each side of the heel). If squeezing the sides of the heel is painful, that's one more piece of evidence that suggests you probably have a plantar fasciitis condition. Of course, this blog is not meant to replace actual medical care and medical evaluation. If you think this is something you have—if you have any foot pain—it's a good idea to get it checked out.
Many times when patients get it checked out, they discover it's been a chronic issue; if you've had multiple issues of pain in the feet, a lot of times physicians will order an x-ray of the foot to see if there is a bone spur because sometimes, if you have ongoing inflammation on the bottom of the foot, you'll start to get excess calcification on that plantar fascia. Once you have excess calcium buildup, it'll turn into a bone spur. That can mean that you might have a much more chronic problem to look at, so many times an x-ray will be taken from the side of the foot so you can see if there's a bone spur underneath that heel. Sometimes providers use diagnostic ultrasound to look at the soft tissues underneath the foot, too, because with chronic plantar fasciitis, you get a lot of degeneration of that plantar fascia. If the generative process goes on for long enough, you can even end up tearing the plantar fascia, which can lead to ongoing dysfunction, dropped arch, or some further problems with the foot. That's not going to happen with every case. That may not happen the first time a person has this, but if you've had a repetitive plantar fasciitis issue, it could become a concern.
If you are experiencing symptoms, we suggest you get it checked out because there might be more than just pain going on and you may need to get some level of care beyond just pain management. You can have ongoing dysfunction and disability from this condition, like inflammation progressing to bone spurs, and then even tissue tearing.
The study that we're looking at with this condition today is titled "Parameters and Effects of Photobiomodulation and Plantar Fasciitis; a Meta-analysis and Systematic Review"; it was published in 2019 in the Journal of Photobiomodulation, Photomedicine, and Laser Surgery. A systematic review is a kind of top-level research where the researchers gather a lot of different individual trials and studies together and look at the results overall. They then determine if a particular type of care is effective or not.
"[P]arameters and effects of photobiomodulation" (i.e., laser therapy or light therapy)—that means the researchers were looking at the settings and the effects for laser in plantar fasciitis care over multiple studies. The authors say that plantar fasciitis will affect about 10% of people at some point in their life, and every year about 2 million people will seek treatment. What can be done about it? Well, obviously laser therapy must be an option because that's what we're talking about today. But in this study, they do say that many times there are options like stretching exercises, therapeutic ultrasound, anti-inflammatory drugs, shockwave therapy, and cortisone injections.
Why are there so many different options? Because plantar fasciitis is a little complex. It isn't simple inflammation. You have to figure out what the cause of that inflammation is... What started it in the first place? No matter what therapy you end up going with, if you haven't figured out the cause and the cause is still ongoing, then the therapy you've chosen is not going to be successful no matter how great it is. For example, if you've got the wrong kind of shoes that don't give you enough support and you're overstretching that plantar fascia with every step, you're going to have ongoing irritation.
So even if you were to take anti-inflammatory drugs that helps it feels better, as soon as you go to walk in those shoes again, with improper support, it's going to create a new inflammatory condition, and you're never going to feel like you get it resolved, even with a cortisone injection. Even if you are receiving a treatment that is great at reducing inflammation, if you don't have proper support in the shoe, you're going to create more inflammation every time you're on your feet, which will counteract the treatment.
We've seen that a lot of these cases can even be traced bank to old sprains of the ankles. A lot of people have rolled their ankles while playing sports or hiking or engaging in some other type of activity. If you have stretched ligaments in the ankles, those ligaments are not able to give the foot proper support, so you end up with more strain going into the structure of the foot because the ankle is just not stable. It overworks the foot. Likewise, if you suffer from knee-instability issues, you walk differently, so you also put strain on the foot differently.
Plantar fasciitis is more of a symptom than a disease.
You need to figure out what the cause is. And many times you're going to need help figuring that out. Make sure you're visiting a really good physical therapist or chiropractor or family care practitioner who is really knowledgeable about this and can help you figure out where those movement deficits are originating. We refer to chiropractors and physical therapists specifically because they may offer additional training in gait management, foot support, and biomechanics.
Once you've gotten that figured out, though, there are a lot of different options available right now: You can use anti-inflammatory drugs, stretching, bracing, shockwave therapy, cortisone injections, and more. Which method should you be choosing? In just about every case, you're going to want to go for the therapy that has the least amount of side effects and the least risk, right? Stretching exercises are always a good idea for pretty much everybody. Your physical therapist is going to be great at getting you some exercises for plantar fasciitis. A lot of chiropractors are going to do well at that too. Many times your primary care medical providers know a lot of these, too, because this is a fairly common condition.
There are nighttime braces that can be worn. There is also good evidence that shockwave therapy can work well, and, although it's not well-proven, therapeutic ultrasound could be used. Anti-inflammatory drugs may be an option for a lot of people, but that's where we start talking about having side effects. Cortisone injections have been shown to have a risk of actually rupturing that plantar fascia, so it might make it feel better, but it does weaken those tissues and makes you more vulnerable to long-lasting injury if that plantar fascia does rupture. The least invasive therapies are the most ideal.
The researchers in this particular study that we're referencing here took over 1,300 individual experiments and studies and clinical trials on plantar fasciitis and laser therapy; they narrowed it down to 7 studies that met their criteria for being very high quality. What they found is that, when infrared laser was used for 3 times per week for 4 weeks, patients got better. That's not to say it's going to work for everybody or that nobody's going to need more than that, or less than that, but those were the best results they saw.
The researchers reported that laser therapy and light therapy presents no serious side effects like those associated with NSAIDS (non-steroidal anti-inflammatory drugs). It's safe. It works quite well. However, you're going to have to be a little bit patient: You can't expect it to be immediately perfect, but after two through four weeks, you should be starting to feel better. You may need more than that, though, because this can be a really tough disorder. But if you can stay away from some of the more invasive interventions, that is ideal. If you're not seeing any positive results within about four weeks of starting laser therapy for plantar fasciitis, though (if you're not seeing any change at all), you need to look at some additional or different treatment. Perhaps you haven't really found the cause yet and you're continuing to strain those tissues.
Again, we're going to recommend: Visit an expert in biomechanics and foot support and have them perform an evaluation. Ask, "Am I wearing the right shoes?" "Am I walking in a way that puts extra strain on the foot?" Provided you're able to find the root cause first, according to this study, there's a good chance that laser therapy may help relieve your plantar fasciitis pain. To find a laser therapy provider near you, view our clinic map.