Introduction

Plantar fasciitis is when the tissue in the bottom of the foot, known as the plantar fascia, starts giving a person pain due to it being overworked.¹ The pain is usually worse in the mornings, the first steps after resting, but it can decrease during the day. The pain can get worse by standing or walking for a long time. Traditional treatments that are used first are non-invasive, usually stretching, and inserts for the sole of the foot or heel inserts.¹ Laser therapy can be used when there is still pain after three months of trying out all the non-invasive treatments, which are listed in this article,² they are also for individuals who do not want to go through surgery. Laser therapy can help reduce pain and repair the plantar fascia without being invasive.

Understanding plantar fasciitis

Anatomy of the plantar fascia

The plantar fascia is a wide piece of tissue that supports the arch of the foot. It is used when the foot pushes off to walk or run, experiencing both the contraction and relaxation of the tissue.¹ 

Causes and risk factors

Causes of plantar fasciitis include overuse of the plantar fascia either through exercise or walking, obesity, high arches, flat feet, and/or the overpronation of the foot.¹ This can also occur in people who spend a lot more time on their feet, such as runners, as the strain of the repeated use of the plantar fascia can lead to injury.² Common symptoms of plantar fasciitis include inflammation and pain in the heel. 

Diagnostic process

Plantar fasciitis can be diagnosed either from the patient's history or through a physical examination. By talking to a patient about any changes in their life, such as a significant weight gain, the patient can then identify where the pain is. If there is a sharp pain in the heel, a diagnosis may be made.² Imaging tests may also be used, such as X-rays, to ensure it is plantar fasciitis and not other injuries that leads to foot pain, for example, stress fractures. 

Overview of laser therapy

Laser therapy is a non-invasive treatment to reduce pain in conditions such as arthritis, knee injuries, and plantar fasciitis.³ There is a low-level laser therapy (LLLT) which is usually used to control acute pain through focused electromagnetic and light radiation.⁴ There is also high-intensity laser therapy (HILT) that can reach and stimulate larger and/or deeper joints in comparison to LLLT.³ Laser therapy reduces pain by relaxing muscle, repairing ligament, and reducing inflammation.⁴ 

Laser therapy for plantar fasciitis has shown to be effective in pain reduction and reducing inflammation in the plantar fascia, as reported in Naruseviciute and Kubilius (2020). It can also help to reduce plantar fascia thickness, as shown by the magnetic resonance imaging (MRI) after treatments, and it can help with tissue repair and regeneration.⁵ According to the participants opinion in Naruseviciute and Kubilius (2020), HILT seemingly had a more significant effect in reducing pain levels in comparison to LLLT. But otherwise, there was no statistically significant difference between the two; they both reduced pain for those with plantar fasciitis.⁵

The procedure of laser therapy for plantar fasciitis

Firstly, in Naruseviciute and Kubilius’s (2020) study, a pain scale was used to evaluate how effective the laser therapy was based on either the LLLT or the HILT. Depending on the type of laser therapy, there were different ways of administration. The LLLT group had a shower applicator, where the laser targeted a larger surface area and used less energy. The entire treatment took 6 minutes and 40 seconds.⁵

The HILT group used a pen applicator, where the laser was targeting a specific area, and was more intensive. This treatment took 7 minutes and 8 seconds. As the aim was to test the efficacy of the two treatments in comparison to each other, they both had the same number of procedures. They were done three times per week over a three-week period. Both therapy types also had two phases of treatment within each of those time frames. The first phase was the “manual slow scanning over the medial border of the plantar fascia”. The second phase involved the “slow scanning of the anatomical site of the enthesis zone of the plantar fascia to the heel and whole heel scanning”.⁵ This shows how the laser therapy addresses the whole part of the foot and targets the specific areas of the plantar fascia.

Advantages of laser therapy

A positive advantage of laser therapy is that it is a non-invasive therapy that can help to reduce the pain of plantar fasciitis and can also stimulate the repair of the plantar fascia. This can be better in comparison to anti-inflammatory drugs; while they can reduce pain, there is not much evidence on repairing tissue.⁵ Laser therapy can be used alongside other treatments, not only at home treatments such as icing your foot or having your foot massaged, but also anti-inflammatory drugs can help to reduce pain. 

It can also help to acknowledge the efficacy of laser therapy when the individual changes their lifestyle. For example, if the person gains weight, they would be putting more pressure on the plantar fascia and therefore, they would be in more pain and it would take a long time for their foot to heal. By using laser therapy, along with lifestyle changes and other at-home treatments, it can reduce the pain and increase the chances of healing faster. 

Limitations and risks

Some limitations of laser therapy include individual conditions, long-term effects, and accessibility. Laser therapy can have different effects on different people, depending on the person's lifestyle, their weight, how much they move, what they eat, if they are adhering to laser therapy aftercare, and the use of other treatments to reduce pain and promote repair of the plantar fascia. 

If the individual is not putting in enough care, the pain can come back. Another limitation would be not knowing the long-term effects of laser therapy, as there has not been much research. The accessibility of the laser therapy is another limitation, as it is expensive to go through, and the type of laser being used (and what the patient can access) can change the amount of pain relief a person gets.

Comparison with other treatments

There are many other treatments for plantar fasciitis. Some are more of home remedies, while others are more on the extreme end. One type of therapy that is often measured against LLLT is extracorporeal shock wave therapy (ESWT). This reduces pain and stimulates healing of the plantar fascia.⁶ Both LLLT and ESWT significantly reduces the thickness of the fascial.⁶ This can be another type of therapy to consider for pain relief due to its high effectiveness rate.

Non-invasive treatments

Plantar fasciitis-specific stretching and strengthening decreased the amount of heel pain. Strength training targeting the sole of the foot has also shown to be helpful in reducing pain quicker than just doing the stretches.² Foot orthoses can help to reduce the strain on the fascia by putting inserts into shoes to provide arch support that can be customised to each individual, pain is reduced this way, but not consistently in the long term.² Taping the foot in strategic areas can be effective in the first week, but the effectiveness wanes after that.² Dry needling/acupuncture in the foot can help to alter blood flow, but this has not been tested enough in quality studies to recommend as a true treatment for plantar fasciitis.² Night splints are used to keep the ankle in a specific position throughout the night. They can be effective but, they often rely on the use of other treatments during the day, such as insoles.²

Invasive treatments

Injections, such as corticosteroids, can be used to decrease pain and inflammation, but does not address the issue of the plantar fascia needing to be repaired. Other injections have been researched, but they come with other issues, such as larger costs for the individual, low likelihood that the injection works, and time limitation in its efficacy.² Surgery is the most extreme type of treatment, and occurs usually when the patient has not improved within a year of treating themselves with non-invasive treatments and/or injections. Once the surgery takes place, the foot needs to rest for at least three weeks, and it could take up to three months to be better. There have been many reports of pain relief due to this surgery.²

Conclusion

Laser therapy is a beneficial treatment that can help with pain relief, the reduction of inflammation, and tissue repair for those with plantar fasciitis. Since it is non-invasive, it does not result in any more pain or strict bed rest requirements, which can be a better alternative to other treatments such as surgery.  Laser therapy for those suffering from plantar fasciitis can target individuals who have tried other non-invasive treatments frequently and extensively, but have not gotten enough pain relief from them. It has been effective for many patients, and more research is being conducted into the different types of lasers, how effective they are at pain relief, and also how cost-effective it is.