Do any supplements help treat or reduce the pain of plantar fasciitis (heel pain)?

Answer:

What is Plantar Fasciitis?

Plantar fasciitis is the most common cause of chronic heel pain in adults. The pain is often described as dull, aching or throbbing, and is typically worst when first putting weight on the foot, such as when getting up in the morning or when standing after being seated. It can occur in just one foot, although up to one-third of cases involve both feet.

In the past, plantar fasciitis was thought to be caused by inflammation of the bands of connective tissue, or fascia, that run along the bottom of the foot, from the back of the heel and arch of the foot to the toes. However, experts now believe that the condition is caused by degeneration of this connective tissue, rather than inflammation (Latt, Foot Ankle Int 2020).

Degeneration of the plantar fascia can occur with age, along with a loss of fat in the foot that helps pad and protect the heel. Degeneration can also occur with overuse (such as in athletes, marathon runners, etc.) and may be more common in people with certain foot conditions or gait postures that increase tension in this area, such as people with a high-arched foot or those who foot tends to roll inwards while walking. Being overweight is also a risk factor for plantar fasciitis, as this may add to the mechanical load of the foot, and weight loss after bariatric surgery has been associated with significant improvement and/or resolution of plantar fasciitis (Boules, J Am Podiatr Med Assoc 2018). Bone spurs (small overgrowths or projections of bone) may develop due to the added friction on the heel bone as plantar fascia degenerates.

Can Supplements Help?

There is little evidence that supplements can help prevent or reduce the pain of plantar fasciitis. However, plantar fasciitis has been reported as a rare symptom of severe vitamin D deficiency, and for this reason, vitamin D supplementation may be helpful in people with plantar fasciitis who are also deficient in vitamin D. This was reported in five women in England with vitamin D deficiency (two of whom had blood levels < 1 ng/mL) that led to softening of the bones (osteomalacia) and plantar fasciitis, and in some cases, bone spurs. All of the women had significant improvement or resolution of their heel pain with vitamin D supplementation and restoration of adequate blood levels of vitamin D, although this took time — from a few months up to two years after starting supplementation (Paice, J Bone Joint Surg Br 1987).

Other supplements that have been proposed to help include vitamins and minerals that play a role in collagen production and/or tissue repair, vitamin C and zinc, and those that have anti-inflammatory effects, such as curcumin (from turmeric), fish oil and bromelain, or that may benefit for joint pain, such as glucosamine or collagen. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) that work by inhibiting COX-2 enzymes are sometimes recommended for temporary relief of plantar fasciitis pain. Theoretically, it's possible that supplements that are also thought to inhibit this enzyme, such curcumin and glucosamine, might also temporarily reduce heel pain. However, there little published clinical research investigating these supplements for preventing or treating plantar fasciitis, or reducing plantar fasciitis pain (Roxas, Altern Med Rev 2005).

Two small studies in Spain among men and women with plantar fasciitis or other conditions causing foot pain (tendinopathy of Achilles, supraspinatus or lateral epicondyle) suggest that a branded supplement (Tendoactive — containing 435mg of mucopolysaccharides, 75mg of collagen type I and 60 mg of vitamin C) may modestly reduce self-reported foot pain compared to standard treatment alone, or placebo (Nadal, Osteoarthr Cartil 2009; Ramirez, Annals of the Rheumatic Diseases 2014). However, due to the small size of the studies and the lack of published data (only summaries of these studies appear to have been published), more information is needed to draw conclusions about these findings.

There is one published report of a woman whose plantar fasciitis resolved one month after she began a gluten-free diet. Interestingly, plantar fascia pain has been reported to occur in about 12% of people with celiac disease who experience joint pain or symptoms (who may also be more prone to autoimmune diseases such as rheumatoid arthritis, ankylosing spondylitis, reactive arthritis and psoriatic arthritis), leading some experts to suggest that autoimmune conditions might contribute to plantar fasciitis in some people. However, in this case, the woman was not diagnosed with celiac disease (although her physicians noted there was a history of celiac disease in her family), and this theory remains highly speculative (Paoloni, Foot 2014).

Can other treatments can help?

Several small clinical trials suggest that four to eight weeks of acupuncture treatment, with or without use of electrical current, may reduce plantar fasciitis pain compared to standard therapy or sham acupuncture (Thiagarajah, Singapore Med J 2017).

Traditional, standard treatments such as foot stretches, physical therapy, splinting and immobilization have a high success rate, with an estimated 90% of people treated with such care achieving symptomatic relief with three to six months. Orthotic shoes and shoe heel wedges and cups designed to decrease heel rise and Achilles' tendon force have also been shown to be very effective. Other treatment options include corticosteroid injections, ultrasound therapy, and, in some more severe cases, surgery (Latt, Foot Ankle Int 2020).