Plantar Fasciitis

Melbourne, Australia

2001

Keywords: plantar fasciitis, wheatgrass, inflammation

Plantar fasciitis (PF) is a common, painful heel condition that can subject some sufferers to physical and associated psychological disability for many years. It is often refractory to treatment, although many cases remit spontaneously. Response to therapy varies as widely as the many interventions available, such as orthotic footwear, steroid injections, extra-corporeal shock wave therapy, anti-inflammatory medication, physiotherapy and surgery. Given the documented, anti-inflammatory effects of wheatgrass1,2 and preliminary clinical observations of symptomatic improvement in patients with plantar fasciitis using a topical wheatgrass cream, this pilot study was instigated to test the efficacy of the application.

The pilot study was performed over the internet. Thirty-one patients were recruited on a first come, first served basis with the approval of the webmaster of www.heelspurs.com, a popular, semi-commercial English language website in the United States . This site offers support and advice via message boards for sufferers of plantar fasciitis and associated heel pain conditions.

Participants were not informed of any of the known effects of wheatgrass, and were promised adequate supplies of the application to cover the three month trial period in return for completing pain level measurements at the requested times. Tubes of cream were despatched to each respondent, and replenished at one and two months after commencement of the trial or on request. Participants were sent a basic questionnaire and a protocol by email. They were asked to report their maximum pain levels on either foot on an ascending scale of 0 to 10 at weeks 1, 2, 3, 4, 6, 8, and 12 following commencement of treatment. Because some pre-trial patients had responded rapidly, often within the first week of treatment, pain levels were requested more frequently in the early stage of the trial period. If updates were not received on the prescribed date, respondents were contacted by email for their pain levels. Once daily application was advised in order to examine the effects of minimal intervention. Participants were instructed to apply a small amount (“rice-grain size”) of cream to the most tender or painful area on either or both heels. Participant responses were collected regularly and descriptive statistics calculated. Baseline and followup pain scores were compared using a paired sample t-test.

Thirteen males and 18 females joined the trial; 29 from the USA , one from Canada and one from Ireland . Twenty subjects had undertaken previous therapeutic interventions which included surgery, extra-corporeal shock-wave therapy and steroid injections. No exclusion criteria were imposed. The average age of participants was 45 years (range 23-68 years) and the mean overall symptomatic period for PF was 48 months (range 9-144 months).

There was a progressive overall decline in mean maximum pain levels over the 12 week period from 6.1 to 3.25. (Figure 1). By the end of the 12th week, 16 participants (51.7%) had a greater than 40% reduction in maximum pain level while four (12.9%) recovered completely. Six subjects (19.4%) experienced no improvement and one suffered an increase in pain and withdrew from the study. The mean +/- (SD) pain at baseline was 6.1 +/-(2.5) and at 12 weeks was 3.25 (2.5). There was a significant difference between pain at baseline and 12 weeks, (p <0.05).

To the author’s knowledge, topical applications have been of little use in the treatment of plantar fasciitis. Extensive research into the therapeutic properties of cereal grasses began in the 1930’s in the U.S.A. , however, no study of the effects of topical wheatgrass applications in the treatment of plantar fasciitis was found in the literature. This study resulted from the clinical observation that several patients with plantar fasciitis responded quite rapidly (sometimes in a day or two) to treatment using the wheatgrass-based topical application. The findings of this study suggest that this application may be a useful and effective adjunct to treatment in some patients. Kubota et. al. demonstrated potent anti-inflammatory effects from barley juice.3 

In a privately funded, unpublished study, the author found indomethacin-equivalent anti-inflammatory responses to carrageenin-induced inflammation on the skin of laboratory rats. Given all cereal grasses are essentially nutritionally identical,4 an effective anti-inflammatory response to wheatgrass extract in some of the trial subjects was not an unexpected finding.

The results of the study are limited by the small numbers of participants, the lack of a control group and by the subjective method of pain measurement by participants. A larger, well-controlled study is indicated.