Plantar Fascia

Recommendation: 

In a systematic review and meta-analysis Wang et al. (2018) evaluated the effect of LLLT treatment on plantar fasciitis. They concluded.

Overall, the analysis suggested that LLLT can significantly relieve pain of PF for 3 months after treatment.

This was consistent with the results of other studies.

Although they could not conclude how the pain was relieved they listed several possible mechanisms.

• peripheral neural blockade,
• enhancement of peripheral endogenous opioids,
• suppression of central synaptic activity,
• inhibition of histamine release,
• modulation of neurotransmitters,
• promotion of adenosine triphosphate (ATP) production,
• reduction of muscle spasm,
• increased production of anti-inflammatory cytokines.

They also conceded that several studies had not shown these positive effects which might have be due to the differences in the treatment protocols and types of LLLT.

In general, 2 types of lasers have been used in the treatment of PF:

1. He-Ne laser
2. GaAlAs/GaAs laser (e.g. Enraf-Nonius Endolaser 120)

Jastifer et al. (2014) showed that GaAlAs laser can significantly improve the pain of PF (e.g. LP500C, CP4X100C, CP4X400C). Compared with He-Ne laser, the GaAlAs/ GaAs lasers performed better (with deeper penetration). Several studies have shown the same reults Cinar, Saxena & Uyguar (2018), Ulusoy et al. (2017) and Kiritsi et al. (2010).  These more recent studies contradict the earlier studies such as Basford et al. (1998) who had reported that the application of GaAlAs could not improve the pain of PF. The inconsistencies in the efficacy of GaAlAs/GaAs laser may result from different doses. Basford et al. (1998) gave 1 J to the calcaneal origin and 2 J to over the fascial arc, which is less than the more recent WALT guidance for LLLT treatment of PF (8 J). As an example Ulusoy et al. (2017) applied LLLT at 8 J to the medial calcaneal area and the myofascial junction, whilst Kiritsi et al. (2010) applied 8.4 J to the tendon insertion and the medial side of the fascia both showing positive results.

In the 2018 study Cinar, Saxena and Uygur found that there was a significant improvement in AOFAS-F total score at 3 weeks and the improvements continued at 3 months for both total score and AOFAS-F (walking distance and walking surface). The LLLT group had lower pain than the control group at 3 months. They concluded:

“The combination therapy of LLLT with usual care is more effective to improve functional outcomes and activity-related pain”

In a 2010 study Kiritsi et al. used US to scan the PF before and after laser treatment (904nm). After LLLT, plantar fascia thickness showed significant change over the experimental period and there was a difference (before treatment and after treatment) in plantar fascia thickness between the treated and placebo groups. Pain estimation on the visual analogue scale had improved significantly in all test situations (after night rest, daily activities) after LLLT when compared with that of the placebo group. (P=0.006 and P=0.01, respectively). Additionally, when the difference in pain scores was compared between the two groups, the change was statistically significant (after night rest P=0.000; daily activities P=0.001). They summarised 904 nm gallium-arsenide (GaAs) infrared laser may contribute to healing and pain reduction in plantar fasciitis.

So it appears that PF treatment is dose dependent with 8 joules being the average – how this is applied though is very varied.

In most studies the application is a mix of origin and medial arch with the dosage spread between the 2 areas.