An Integrative Approach for Plantar Fasciitis
REHAB
Jerome Rerucha
DC, BS, CSCS, CHPS
As the holistic health and fitness market continues to grow, it makes good business sense for chiropractors to integrate goods and services into their practices that complement this trend. This will enable offices to reach out to potential new patients as well as being able to offer additional options to enhance the needs of existing patients.
Plantar fasciitis is a common condition in all communities. This symptom of chronic foot and heel pain can affect those of all ages, men, women, athletes, and sedentary individuals alike. Chronic foot and heel pain is so common that every CVS, Walgreens, and Wal-Mart has an unattended foot scanner to sell shoe inserts to those just passing by it. The same company that provides the unattended scanner has such a large national target audience that expensive television commercials and print ads offer affordable methods to drive continued sales.
Competing in this existing market, with superior service and results, offers the chiropractic community a great opportunity. Chiropractic provides the proven value of extremity adjusting, soft-tissue correction, low-level laser therapy, rehabilitation techniques, and other enhanced services for full-service collection.
The Adjustment - There are 26 bones in each foot and 206 bones in the entire body. It is a valuable service for all patients, even those without specific foot symptoms, when the chiropractor adjusts feet consistently. The feet not only need to be aligned properly, but they also need to be conditioned for flexibility and strength. In everyday life and sport, we transfer power from the ground to some other distal area of the body. Proper symmetrical foot mechanics greatly affect knee stress, pelvic leveling, and the entire spine; upper extremities are all reactive to foot mechanics.
Low-Level Laser Therapy - The therapeutic laser boom in the United States started in the chiropractic market and continues to gain popularity due to its numerous, safe, and effective applications. LLLT is also one of the most validated and researched
^Chiropractic provides the proven value of extremity adjusting, soft-tissue correction, low-level laser therapy, rehabilitation techniques, and other enhanced services for full-service correction. 5 5
devices in all of health care. As of the date this article was written, there were 5,227 articles in PubMed validating the use of LLLT. In short, low-level laser therapy is proven to enhance the mitochondria and to increase the production of adenosine triphosphate (ATP). The increase in ATP improves cellular regeneration, decreases inflammation, and enhances the efficiency of all phases of healing.
Low-level laser therapy can be used for many conditions within a chiropractor's scope of practice. To advertise a service in any media for a “specific indication of use,” the particular product or service has to be cleared by the FDA. Great news for chiropractors! There is a brand-specific laser that was researched in a level 1 clinical study and has received FDA market clearance (K132940) to successfully treat “chronic heel pain arising from plantar fasciitis.”
Patients were selected for the random, double-blind, placebo controlled clinical study who had chronic foot and heel pain for a minimum of one year, and a majority of participants suffered upward to 10 years. Only (brand-specific) LLLT was administered and compared to a placebo group.
Patients were treated twice a week for three weeks for a
total of six treatments and were evaluated at baseline, which is the end of the active treatment period. Follow-up reevaluation was performed at two weeks' post-procedure, and six and 12 months post-procedure, showed continued progress although no additional laser treatment was performed past the three-week mark. No other treatment or consult of any kind (adjustments, rehabilitation, nutrition, soft tissue, etc.) was allowed or performed during the 12-month follow-up. Patients completed the visual analog scale (VAS), foot function index (FFI), and Doppler ultrasound at each of the study’s follow-up periods.
Results: Patients demonstrated a mean improvement in heel pain VAS from 67.8 out of 100 at baseline to 6.9 out of 100 at the 12-month follow-up period. Total FFI score unproved from a mean of 106.2 at baseline to 32.3 at 12 months' post-procedure.
I believe regenerative medicine is the future of medical technology. Applying FDA-cleared LLLT in practice will not only help our patients, but it will also create a referral basis in the future.
Rehabilitation - Movement testing and functional evaluation are useful tools I use to attract new patients. I demonstrate the benefit of chiropractic adjustments and programs involving the need for low-level laser therapy, soft-tissue correction, and, of course, a program of clinical exercises for the areas that scored below “baseline normal” for the patients’ physical competency. In my clinic, every person must achieve a certain level
Chart 2: VAS Averages Across Baseline, Endpoint, 6 Months and 12 Months Post-Procedure Evaluation Points
of whole-body “physical competency” (not just symptomatic area). This approach provides benefits beyond mere symptom relief and will significantly improve prevention for long-term well-being. The outcome of my complete functional movement exam creates a “thr ee-dimensional body map” from toes to nose, demonstrating needed corrections and not just identifying the area of symptomatology.
For this article, I will use just a short but powerful demonstration related to those who have chronic foot and heal pain. I use a multilevel slant board to test foot dorsiflexion and calf flexibility, and a specific calf exercise device to determine neurological strength and function. Each of these exams, with the specific devices, are reproducible for pre-and post-
testing. These devices provide me with the ability to detect dysfunction causing existing symptoms; and more importantly, to show patients, even those without symptoms, how their inflexibility and weaknesses compare to normal and how they are predisposed to injury. Using the slant board to determine inflexibility educates the patient on the need for adjustments, soft-tissue
release using percussion, and laser therapy. Using the calf exerciser and displaying weakness clearly shows the person the necessity of a supervised clinical exercise program and laser treatment to the nerve roots and the area of involvement, as well as the need for specific adjustments. The measurable improvements achieved using these tools and the advanced corrective methods employed demonstrate the usefulness of these devices and impresses the patient with your advanced knowledge.
Soft-tissue Collection -Inflexibility in calf muscles is easily identified with the previously mentioned exams and treated with the application of a percussion instrument. Initially, I will use a fascial roller breaking up adhesions and stimulating circulation and the lymph system. Then I place a particular trigger-point head on a percussor device to provide an excellent tool to use on specific areas of the calves and on the bottom of the foot, on the plantar fascia surface, and on the arches of the foot. Both of the described percussor treatments, as well as any soft-tissue technique correction, is significantly enhanced by applying laser at the time of treatment or separately.
As chiropractors, we understand how improper foot mechan_ics can cause numerous other common
issues thr oughout the body, even when the feet are asymptomatic.
The average person does not understand the benefits that chiropractic adjustments provide in delivering unproved health and well-being and in optimizing biomechanics for the athlete, as well as the general population. It is up to us, as chiropractors, to educate others about the many benefits that chiropractic and integrative services can offer.
Jerome Rerucha, DC, BS, CSCS, CHPS, is a practicing clinician, co-owner of CrossFit Eatonton with his wife and an international speaker teaching integration of advanced clinical treatment applications
and competitive strength and conditioning principles. Prior to clinical practice he was a full time strength coach, competed in powerlifting for 14 years winning numerous titles including a Lifetime Drug Free World Title and The Best Lifter Award in 1999. Hcn’ing the personal competitive lifting experience, coaching numerous types of athletes and elite strength athletes provides additional benefits when teaching his dynamic Chiropractic applications. You may contact Dr. Rerucha at jeromererucha@gmail. com
