Osteopathic Manipulative Treatment (OMT for short) is a treatment for Plantar Fasciitis that involves manipulating the bones and connective tissues in the foot to help them align properly, bear weight more effectively, and work correctly in tandem with the arch of your foot.
This noninvasive treatment is usually performed by an osteopath, a doctor who specializes in holistic (whole-body) medicine and musculoskeletal problems. Osteopathic doctors typically emphasize noninvasive treatment options and proper alignment as the basis for healing.
What is OMT, what are the pros and cons of this type of treatment, how much does it cost, and where can you find a provider for this treatment?
What is OMT?
OMT, or Osteopathic Manipulative Treatment is a type of physical therapy for Plantar Fasciitis that helps realign the bones and soft tissues in the foot.
Unlike some treatments, OMT takes a whole-body, holistic approach to healing. In other words, while your osteopath will gently manipulate your foot bones and tissues, he or she will also look at the alignment of your ankles, legs, and hips.
Robert Truax, DO, says. “For [pain from plantar fasciitis] the evaluation and treatment both begin with the hips. I evaluate the lower back and pelvic areas because the foot lands where the hips tell it to. If there is tightness or restriction in the hips, the foot lands incorrectly, setting up abnormal stress loads that can result in pain.”
During each treatment session, your doctor will apply gentle pressure, targeted stretches, some elements of massage, and other exercises to encourage the bones, muscles, and ligaments to align properly. You can also expect to be given “homework” in the form of additional exercises and stretches, rest and icing, taping, and wearing orthotic insoles to help stabilize gait, support the arch, and align the posture properly.
Pros and Cons of Osteopathic Manipulative Treatment
While OMT isn’t backed by a lot of evidence, the pros outweigh the cons for many people with plantar fasciitis:
Pros of Osteopathic Manipulative Treatment
In general, OMT has very few risks, and uses many different techniques that are supported by solid evidence (like stretching and orthotics!)
Noninvasive and Painless
OMT doesn’t involve incisions, surgical instruments, or expensive equipment. The experience is painless and totally noninvasive.
While costs of OMT can vary depending on your provider and whether the treatment is covered by insurance, most people end up paying somewhere in the neighborhood of $100 per session, a small cost in comparison with many treatments. Some osteopathic doctors offer discounts for booking several sessions at once.
Significant Anecdotal Evidence, and Proven Techniques
While OMT doesn’t have the distinction of many scientific studies or clinical trials, it does incorporate a lot of proven conservative treatments for plantar fasciitis, including stretching, icing, massage, and the use of orthotics.
OMT also has plenty of anecdotal evidence to back it up, from people who have had success with an osteopathic doctor. If you’re considering OMT, it can be helpful to talk to real people who have had this type of treatment.
Plantar fasciitis usually develops as a result of multiple factors and multiple body systems (like excess body weight combined with improper gait, combined with overuse in exercise). It only makes sense that a whole-body approach to plantar fasciitis that takes into account gait, alignment, posture, and musculoskeletal health along with biomechanics in the foot, ankle, hips, and legs would be very helpful in healing.
Cons of Osteopathic Manipulative Treatment
OMT doesn’t have a lot of evidence to back it up, which is the primary con. You should also take care that your provider uses non-thrusting techniques, which have the potential to damage bones and tissues.
Minimal Clinical Evidence
A review of OMT-related studies conducted by Warwick Medical School showed that more evidence, and higher-quality studies are needed to make any definite conclusions about osteopathic manipulative treatment.
However, this doesn’t mean this treatment is ineffective–it just means OMT hasn’t been proven effective. It just means that you should proceed with caution before investing a lot of money or time into this procedure. Given the minimal risks and side effects from OMT, many people feel that this treatment is worth a try–and many have had significant success!
Caution with Thrusting Techniques
Thrust techniques aren’t usually part of plantar fasciitis treatments; however, these more abrupt, forceful movements can carry a higher risk of trauma or complications, so talk to your osteopath before your treatment to ask about what techniques will be used, and whether your OMT will be low or high velocity, and thrusting or non-thrusting.
Where Can I Get OMT?
You’ll need to find a DO, or doctor of osteopathy to get OMT treatment. You can find a DO in your area on osteopathic.org. Make sure to ask the osteopath you choose whether or not they offer this treatment, since some practitioners may not offer certain treatments.
In case you’re wondering, an osteopath has completed four years of medical school, and many have additional medical training. Your osteopath will be able to help you with OMT, and is also fully authorized to prescribe and perform other medical interventions and prescribe medications.
Is OMT right for you? For many people with heel pain from plantar fasciitis, the answer is a resounding yes. And while this modality doesn’t have a lot of high quality studies or evidence backing it up, that just makes it extra important to do your research, know what to expect, and proceed with caution while continuing proven conservative treatments for plantar fasciitis like orthotics, stretching, icing, and rest.
What does posture mean? To many people it indicates the difference between someone who’s having a good day versus someone who’s down on their luck. Slumped shoulders and a hunched stance might indicate boredom or a lack of confidence, while an upright back and squared shoulders can convey confidence and interest.
Posture communicates plenty–but what posture communicates about your health is one of the most important things you should be aware of. Because it turns out that when your mom told you to sit up straight, she was on the right track. However, science tell us that when it comes to posture, she should have been just as worried about your feet!
Why? Keep reading!
Posture Basics, Head to Toe
Poor posture–hunching, sunken shoulders, and a slumped back–can have a dramatic effect on your muscles and ligaments. It can lead to injuries of the knees, heels, feet, back, and even difficulty with breathing and digestion. Bad posture is typically caused by–and exacerbated by–an imbalance in your muscles in strength and tension, and the muscles in your feet play a critical role. For example, tight calf muscles paired with weak plantar fascia can wreak havoc on your gait and foot posture (the alignment of the foot itself). This poor posture is a vicious cycle, causing the body (which naturally leans slightly forward) to tilt further forward or backward, adding additional strain to your feet and heels, and making plantar fasciitis–and posture–worse.
Postural Benefits of Wearing Orthotics
Wearing orthotics can have a tremendous positive impact on good posture, since the way the feet absorb and distribute impact has a big effect on the rest of the body. While orthotics are often seen as just a solution for heel pain, they can also be used as simple at-home solution to improve posture in the following ways:
Correct Gait Abnormalities
Your feet are your foundation every time you run, walk, jump, or stand. The impact from these simple daily activities, combined with the weight of the human body can place a great deal of strain on the heel and arch of the foot. Over time, as the body tries to compensate for this strain and pain, gait abnormalities can develop that result in poor posture.
Since orthotics help lift the arch to an optimal height and cushion the heel, the feet (and therefore the ankles, legs, hips, etc.) are more balanced, helping you avoid stumbles and falls that can injure or throw any number of the body’s muscle groups, bones, or tissues out of alignment and creating poor posture.
Pronation is where your foot turns too far inward as you step forward, causing the arch to flatten excessively. Pronation is associated with increased incidences of plantar fasciitis, heel pain, gait abnormalities–and poor posture. Orthotics can help correct overpronation while you walk.
Distribute Weight and Impact More Effectively
Because orthotics cushion and support the arch, you’re able to more effectively distribute and bear the weight of walking, running, and jumping. And when your arch is able to do its job in absorbing impact effectively, you’ll feel less aches and strain to your hips, back, and legs.
What to Look for in Orthotics to Improve Posture
There are a lot of different orthotics to choose from on the market. If you’re looking to improve your posture, you’ll want to keep an eye out for the following qualities:
Lightweight: Heavy orthotic shoes can negate some of the positive postural effects of using orthotics in the first place, and don’t allow for much flexibility in rotating between different pairs of shoes. Look for lightweight orthotic inserts that can be added to any pair of shoes.
Cost effective: There’s not much evidence that expensive prescription orthotics are any more effective than inexpensive orthotic inserts (some of which are more than 90% effectivein treating heel pain and plantar fasciitis!) Balance quality with cost!
Cushioning and Supportive: The perfect blend of support and cushioning can be surprisingly hard to find. If you can crush your orthotic insert in your hand, it’s not likely to stand up very well to the rigors of walking, running, or jumping. Make sure your chosen orthotic is sturdy enough to stand up to some pressure while still providing cushioning for your heel and arch.
Fascia Bar Technology: This patented technology brings the arch to the optimal height for support and comfort during physical activity. This innovative technology helps the arch tremendously with weight distribution and impact absorption.
Other Ways to Improve Posture
Another great way to improve your posture from the feet up is by using simple stretches to make sure that your muscles and tendons are limber and not too tight. Taking a few minutes every day to stretch your calves, fascia, and other muscles and tendons in the feet and legs can make a world of difference. When your muscles are limber and stretched, you’ll avoid a situation where one group of muscles is pulling another forward or backward subtly, throwing off your stride–literally.
Proper stretching and properly supporting the feet and heels help ensure that your weight falls on the balls of your feet first as you walk–instead of your heel. With a heel-first gait (caused and exacerbated by bad posture), your feet absorb greater impact and aren’t able to propel the body forward as effectively–meaning you’re having to work extra hard to walk the same distance and putting additional strain on your fascia and heels.
Improving Foot Posture
As you work to improve your overall posture, make sure you don’t neglect the posture of your feet themselves. Improving overall posture is hard to do when your feet–which support the weight of your entire body–aren’t in the correct position!
Properly aligned feet should face forward, rather than one or both feet turning inward or outward. As you properly support your feet and stretch your calves, heels, and fascia, you should find that your feet align more properly and that physical activity becomes more comfortable as well. An additional method that can be taken to improve foot alignment if you’d like to see faster results is wearing a night splint that supports your feet and heels, and keeps the fascia limber even while you’re sleeping.
By correcting your posture from the feet up, not only will you look better–and communicate more confidence to the people around you–but you’ll feel better and avoid future injuries with a body in balance.
There’s plenty of anecdotal evidence for most Plantar Fasciitis treatments. Everyone has a cousin or friend of a friend who swears by a particular way of banishing heel pain.
But what does the evidence say?
While anecdotes and recommendations from friends and family shouldn’t be discounted–especially if the treatment is affordable and low risk–it’s also important to know how different treatments stack up in clinical studies and peer-reviewed journals. Looking at this evidence, alongside recommendations from people you know and love, can help you make the best decision for your foot health and healing.
Evidence-Based Plantar Fasciitis Treatments
In this article, we’ll review some of the treatments for Plantar Fasciitis and heel pain that are backed by the most high-quality evidence. Each of these treatments has been legitimized by rigorous double-blind, peer reviewed studies and documented by scientists, doctors, and podiatrists in journal articles and highly regarded publications.
Since expense and invasiveness are usually the biggest deciding factors in treatment options, we’ve divided these evidence-based treatments into inexpensive and noninvasive, moderately expensive and minimally invasive, and expensive and invasive categories.
Inexpensive, Non-Invasive Treatments Backed by Evidence
Surprisingly, some of the simplest, least expensive treatments for plantar fasciitis are also backed by the most evidence.
That’s why the overwhelming majority of podiatrists and doctors recommend trying these proven, effective treatments for heel pain before moving onto more expensive options. Numerous studies, including research published in American Family Physician, show than 90 percent of patients can resolve their Plantar Fasciitis using only noninvasive and conservative methods.
The effectiveness of orthotic inserts is heavily debated. But evidence like Blake and Denton’s review of orthotics’ effectiveness published in the Journal of the American Podiatric Medical Association show that orthotics generally have 70%-90% effectiveness. And this study published in the Journal of Foot and Ankle Research shows that even non-custom orthotics can reduce the load on a damaged arch by 34%.
It’s important to keep in mind that not all orthotics are created equal. A double-blind study conducted by the University of Iowa found that Heel Seats, with patented Fascia-Bar Technology, are twice as effective as a leading orthotic insert. Heel Seats lift and realign the plantar fascia, target pain with acupressure, and cushion the heel for pain relief.
Stretching and Massage
Dr. Emily N. Schwartz’s review of different plantar fasciitis treatments confirmed that stretching and massage are two of the most effective at-home treatments for plantar fasciitis.
Stretches that improve flexibility and strength in the arch, Achilles tendon, ankle, calf, and legs can help the arch and supporting systems bear weight properly, and distribute impact. Massage can help improve blood flow to the injured area as well as break up scar tissue and adhesions.
Taping and Splinting
Dr. Podolsky and Dr. Kalichman’s review of several clinical trials and studies showed that taping is an effective short-term treatment method plantar fasciitis. Taping helps relief pain, apply soothing pressure with a gentle stretch, and stabilize the arch.
Splinting, similar to taping, helps keep the foot flexed in a mild stretch to reduce the morning pain and stiffness that is common with plantar fasciitis. In one study published by Clinical Orthopaedics and Related Research, 68% of participants improved their plantar fasciitis pain by using a night splint. In other studies, participants have reported struggling to use night splints consistently because of the hard brace. In these situations, Sock Night Splints can be a softer, but still effective solution.
Icing is a tried-and-true technique for many different types of pain relief–not just plantar fasciitis! Researchers from the Department of Physical Therapy at Loma Linda University showed that cold therapy (icing) was very effective in relieving pain and even reducing the thickness of the plantar fascia (one of the telltale signs of plantar fasciitis!).
Moderately Expensive, Minimally Invasive Treatments Backed by Evidence
For about 10% of people, at-home treatments for Plantar Fasciitis are not effective. If conservative treatments aren’t working after 9 months to a year, it may be time to consider moderately expensive and minimally invasive treatments backed by evidence.
These treatments are generally less than $200 per treatment, depending on your insurance coverage, show a great deal of promise in studies and clinical trials, and require minimal downtime.
Radiation therapy uses a very low dose of radiation (similar to an X-ray) to This therapy is also on the lower end of cost, has minimal side effects and risks, is simple and non-invasive, and is not painful.
A key study by Dr. Robert Michael Hermann, MD, showed that radiation therapy can be a very effective non-invasive treatment method for plantar fasciitis patients. A 2012 study by the American Society for Radiation Oncology confirmed that 80 percent of study participants reported complete pain relief after radiation therapy, and 64 percent were still pain free after 48 weeks.
Ultrasound therapy uses sound waves to break up tissue, improve blood flow, and reduce inflammation in painful feet and heels. The procedure is easy, quick, and relatively painful.
Evidence from several studies shows that ultrasound therapy can improve heel pain by up to 90%, including a 2013-2014 study conducted by Advanced Medical Imaging that followed 65 patients with chronic plantar fasciitis who used ultrasound therapy.
Intracorporeal pneumatic shock therapy (IPST):
This newer therapy is inexpensive, minimally invasive, and shows a great deal of promise in treating Plantar Fasciitis. IPST uses a small probe that emits shock waves to break up heel spurs. It requires local anesthesia, but minimal downtime. One double-blind clinical study conducted by the medical faculty at Mustafa Kemal University showed a 92% success rate in pain reduction with IPST.
More Expensive Medical Interventions Backed by Evidence
These evidenced-based methods for treating plantar fasciitis can be very effective, but are usually only recommended after more conservative or less expensive methods have been exhausted, because of the recovery time and expense involved:
Topaz Surgery, or Topaz Coblation therapy, uses a tiny wand to make a few dozen holes in a grid pattern over the plantar fascia. As these holes are made, the wand releases small amounts of radio wave energy to destroy and remove bits of tissue to break up scarring and encourage a healing response.
Either local anesthesia or sedation may be used. And while recovery time is much easier than surgery, a walking boot and orthotics should be used, and total recovery time takes 4-6 weeks.
Topaz surgery has been approved by the FDA since 2002, and a study by Department of Orthopaedic Surgery at Singapore General Hospital showed that Topaz is a very effective medical intervention for plantar fasciitis. A study published in Foot and Ankle Surgery in 2016 showed that Topaz has an 80% success rate (similar to traditional surgery).
Plantar Fasciitis Surgery
While surgery is a big decision, it can be a good choice for individuals whose heel pain is chronic or does not respond to conservative treatments. Studies conducted by doctors and researchers at the New Britain General Hospital and the Center for Orthopaedic Care, among many others show success rates of 80% to as high as 96%, with few complications.
While surgery does require more downtime and recovery time, the evidence is clear that this last-resort is generally extremely effective.
You have plenty of choices when it comes to how you will treat your heel pain. But the most important deciding factors in getting you back on your feet should be evidence of effectiveness combined with your own unique health needs!
Whether you’re able to resolve plantar fasciitis using conservative treatments like orthotics and stretching, or need to have plantar fasciitis surgery, the goal is the same: helping you walk, move, and enjoy life without pain.
You may have heard that the thickness of your plantar fascia ligament is related to whether or not you have a condition called Plantar Fasciitis.
But what exactly does that mean? How thick is the average plantar fascia ligament? Why does the ligament get thicker in response to Plantar Fasciitis? How will you know if your plantar fascia is thicker than normal? And what can you do about all of it?
This blog post will cover everything you need to know about plantar fascial thickening.
Normal Plantar Fascia Vs. Thick Plantar Fascia
Just how thick is too thick? Several studies have shown that a healthy plantar fascia ligament runs between 2-4 mm thick in about 90% of people. Women usually have a thinner plantar fascia ligament than men (which may be another reason that women are more likely than men to get plantar fasciitis in the first place!)
Some outliers who don’t suffer from plantar fasciitis may have a plantar fascia ligament as thick as 5 mm. However, numerous studies have shown that for the most part, when the arch of the foot is thicker than 4 mm, there’s a very strong correlation with Plantar Fasciitis.
A study by Dr. Karabay MD, Dr. Toros MD, and Dr. Hurel MD, showed that individuals with heel pain had a plantar fascia thickness measuring an average of 4.79 mm.
Don’t worry: A thick arch doesn’t cause Plantar Fasciitis. It’s just a strong indicator that Plantar Fasciitis is present!
What Is Plantar Fascial Thickening, and Why Does It Happen?
A thicker plantar fascia ligament often goes hand in hand (well, foot in foot) with a diagnosis of Plantar Fasciitis for a couple of reasons:
- Wear and Tear: Plantar fasciitis is caused by wear and tear, trauma, tiny injuries, or overuse of the plantar fascia ligament. A healthy arch distributes weight and absorbs impact sort of like a spring. But with enough trauma, overuse, and injury that spring will collapse–and the feet will flatten. Research from Chang Gung Memorial Hospital has shown that flat feet are related to plantar fascial thickening. Some experts speculate that this tissue thickening happens for the same reason a callus or bunion develops–too much use, pressure, or damage.
- Scar Tissue: Scar tissue can be another reason why the plantar fascia ligament might be thicker than usual. Over time, as the body attempts to support and heal the damaged fascia, tiny lesions and scar tissue can build up, adding extra bulk.
- Swelling: Inflammation and swelling in the area may lead to a thicker plantar fascia ligament.
Identifying a Thickened Plantar Fascia
MRI or ultrasound imaging are two of the most common tools doctors will use to see if the plantar fascia is thickening. These tools show a clear picture of soft tissues in the foot including muscles, ligaments, and tendons.
MRI and ultrasound can also help rule out stress fractures, as well as pinpoint erosion of the fatty heel pad (another telltale sign of Plantar Fasciitis) and heel spurs. Identifying a thickened plantar fascia can help your doctor confirm a diagnosis of plantar fasciitis, since this is one of the most reliable indicators of the condition.
How Can You Prevent Plantar Fascial Thickening?
The best way to prevent plantar fascial thickening is to keep the arch of your foot healthy, supported, and rested.
- Try to avoid long periods of standing when possible
- If your feet or heels hurt or look red and swollen, ice them to bring down the pain and inflammation
- Maintain a healthy body weight when possible, to avoid putting excess strain on your arch
- Wear high-quality orthotic insoles to cushion and support your arches when standing or walking
- Stretch your feet, ankles, and legs to improve strength and flexibility in your arch and supporting muscles and ligaments
Most people don’t have any idea they have a thickened plantar fascia ligament–until heel pain strikes. Thankfully, with easy at-home preventative treatments like these, you can maintain your arch health–and avoid plantar fascial thickening!
Radiation therapy, also known as radiotherapy, is a medical treatment that uses a targeted dose of radiation (a type of energy) to break down certain types of tissue in the human body.
Higher doses of radiation are commonly used to shrink cancerous tumors. Lower doses of radiation, on the other hand, can be used to break up scarring and damaged tissue in the ligaments of the heel and arch.
An important study by Dr. Robert Michael Hermann, MD, found that radiation therapy is an effective non-invasive treatment method for a high percentage of plantar fasciitis patients. Here’s what you need to know before you decide to give radiotherapy a try!
What Is Radiation Therapy (Radiotherapy)?
Radiation therapy uses the same kind of energy that’s used in X-rays to damage or destroy certain kinds of tissue.
While radiation therapy might sound a little intimidating–since it’s the same type of therapy used to treat breast and prostate cancer patients–you should know that the radiation therapy for Plantar Fasciitis is delivered in a much lower dose.
Radiation is measured in units of (Gy). Cancerous tumors are usually targeted with a dose of approximately 60 or 70 Gy per treatment (high enough to break down the DNA and molecules of a cancerous tumor). Plantar Fasciitis, on the other hand, is usually targeted with a dose of only 3 Gy–about 20 times less.
What to Expect From Radiotherapy for Plantar Fasciitis
One of the most common concerns about radiotherapy for Plantar Fasciitis is the potential side effects. Many people are aware of the unpleasant side effects that sometimes happen from higher-dose, tumor-targeting radiation, which can include hair loss, fatigue, and skin irritation.
However, it’s important to understand that the tiny dose of radiation delivered during radiotherapy for Plantar Fasciitis won’t cause these side effects. Radiotherapy itself is very quick and completely painless, and may take as little as five minutes.
In the days following radiotherapy for Plantar Fasciitis, you may notice a small amount of swelling or redness, which will pass quickly. However, you will be able to walk as you normally do. (Remember to wear orthotics to support your healing arch and avoid reinjury!)
In general, radiotherapy treatments for Plantar Fasciitis are administered once or twice a week, for a course of six to eight weeks. The cost of radiation therapy will vary depending on your insurance coverage, but many insurance companies cover the procedure, and you may only be responsible for a copay.
Is Radiation Therapy Effective for Plantar Fasciitis?
The reason radiotherapy is effective at destroying cancerous tumors is that the targeted radiation completely completely destroys cancer cells. This high dose of radiation will, of course, also damage normal cells. However, these normal cells have the ability to repair themselves–while the cancer cells do not.
When it comes to Plantar Fasciitis, low doses of radiation break down painful scar tissue in the heel and arch. The small dose of radiation can also trigger a healing response, as the cells that have just sustained some damage repair themselves.
In a recent study by Dr. Hermann MD, 200 patients were treated with radiation therapy for Plantar Fasciitis. Three months after the course of radiation therapy, almost 70% were pain free or had very little pain. At 54 months, a little over 60% were still pain-free or almost pain free.
Are You a Good Candidate for Radiation Therapy?
While most cases (over 90%) of Plantar Fasciitis respond well to conservative treatments such as orthotics, physical therapy, icing, and stretching, other cases are more stubborn.
For chronic, complex, or debilitating cases of Plantar Fasciitis, surgery may seem like the only option left. But if you’ve tried conservative options without success, noninvasive radiation therapy can be a great option before you undergo the expense, pain, and recovery of Plantar Fasciitis surgery.
If you’re considering radiation therapy for Plantar Fasciitis, talk to your doctor about your questions and concerns–especially if you’re looking at having surgery. While everyone’s health and circumstances are different, radiation therapy shows a great deal of promise as a less expensive, less invasive alternative to surgery.