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Plantar fasciitis, a common and often debilitating condition causing heel pain and discomfort, affects millions of individuals worldwide. While there are various treatment options available, one promising and non-invasive method that has gained significant attention is the use of Transcutaneous Electrical Nerve Stimulation (TENS) machines. This comprehensive guide aims to delve into the world of TENS therapy for plantar fasciitis, exploring its mechanism of action, benefits, proper usage, and practical tips for effective pain relief and enhanced healing.

 

Plantar fasciitis or plantar fasciopathy is a condition that causes pain along the sole and/or heel of the foot. It is the most common reason for foot pain, accounting for 11-15% of all cases [1]. With an estimated 300,000 Australians suffering from this condition, plantar fasciitis impacts the lives of many, especially females and those over 45 [2]. 

 

What is Plantar Fasciitis?

 

Plantar fasciitis occurs with long periods of inflammation along the plantar fascia. This webbed structure covers the undersurface of the foot and is responsible for shock absorption and preserving the foot's arch. Long periods of inflammation in this area can eventually lead to symptoms such as foot pain, difficulty walking and heel pain. 

 

How Does Plantar Fasciitis Happen?

For many people, plantar fasciitis is a progressive condition that begins with no or few symptoms but eventually worsens over time. Many factors contribute to plantar fasciitis, but the most common reason is overuse. Many people find that a sudden increase in weight-bearing activities, such as walking or running, can worsen symptoms. However, other risk factors increase the chance of developing this condition, including [3]:

 

  • Those with pre-existing heel spurs
  • Being overweight or obese
  • Reduced heel pad size
  • Aging
  • Abnormal foot posture
  • Tight calf muscles
  • Working in occupations that require you to stand for long periods

Range of Plantar Fasciitis Symptoms

The most common symptom of plantar fasciitis is heel pain. This is usually worse during weight-bearing activities (e.g., standing, running, etc.) and noticeable after taking a few steps after getting out of bed. Other symptoms associated with plantar fasciitis include:

  • Pain in the heel of the foot
  • Stabbing or burning pain on the bottom of the foot
  • Pain that worsens with activity, especially after prolonged standing or walking
  • Stiffness in the foot and heel
  • Swelling or inflammation of the heel
  • Tenderness in the arch of the foot
  • Difficulty standing up or walking after sitting for long periods of time
  • Pain that is worse in the morning, upon waking up
  • Pain that is often described as sharp, dull, or achy.

 

Common Type of  Plantar Fasciitis

Plantar fasciitis can be separated based on the stages of the condition.

 

Early or acute plantar fasciitis first occurs in response to excessive stress to the load onto the foot. This results in swelling, stiffening and thickening of the plantar fascia to support the sole. The condition is more easily reversed in this stage with conventional treatment.

 

Later or chronic plantar fasciitis can occur if the earlier stages are not addressed. During this stage, the collagen in the plantar fascia begins to become degenerative and cause micro-tears in the tissue [4]. These degenerative changes can be more challenging to reverse and may require more invasive treatment. 

 

Potentially chronic conditions like plantar fasciitis should be addressed as early as possible to prevent worsening. 

 

Common Treatment Method for Plantar Fasciitis

Most episodes of plantar fasciitis are treated conservatively with treatments such as podiatry, physiotherapy, corrective exercises, orthotics and medication. In more severe cases, invasive treatments, such as corticosteroid injections, shockwave therapy and even surgery, may be required to alleviate symptoms. Despite these treatments, some people may experience foot, heel, and toe pain symptoms. 

 

What is a TENS Machine, and How Can It Help Relieve Plantar Fasciitis?

 

A TENS machine stands for transcutaneous electrical nerve stimulation. It is a type of medical device used to help alleviate pain. A TENS machine uses attachable gel pads to deliver electric current through the skin and into the body. The treatment provided through a TENS machine has been calibrated to suppress and/or inhibit the pain signals that travel from outer body regions such as the foot and plantar fascia [5].  

 

 

What's the best way to use a TENS machine for Plantar Fasciitis?

Specific factors to consider when using a TENS machine include duration, mode, use of accessories and settings. These will be addressed using the topics below. However, the TENS machine is the most effectively used when treating pain symptoms from plantar fasciitis, including soreness, achiness or sharp discomfort [6]. 

 

Planar fasciitis is most effectively managed through multiple treatments, including TENS machine, therapeutic exercises, orthotics and lifestyle changes. Researchers have shown that this method significantly improves pain and function in those with plantar fasciitis within 4 weeks to 3 months [7]. Consulting health professionals, such as physiotherapists and podiatrists, about your plantar fasciitis, is advised to help improve outcomes. 

 

Here are the best practices for using a TENS unit:

 

While there are optimal practices for using a TENS unit to treat plantar fasciitis pain, each individual may respond differently. Consulting a healthcare professional with knowledge about electrotherapy would be advised to help tailor a treatment plan. The best practices for using a TENS unit for plantar fasciitis pain will be detailed below. 

 

  • Position of electrode pads for Plantar Fasciitis:

Pain relief is often provided to the area between the placement of the gel electrode pads. Typically, the pain associated with plantar fasciitis is located between the sole and heel of the foot. As a result, we recommend placing one pad at the bottom of the heel and the other pad at the base of the toes. For extended gel pad use, clean the area of application beforehand. Each TENS unit will have a guide detailing the placement and usage of the pads for plantar fasciitis.  

 

 

Conductive Socks and Slipper as alternative to Electrode Pads:

Instead of using electric pads, you can hook up your TENS machine to conductive socks or slipper sandals from the Caremax store. Instead of using sticky gel pads, you can gain complete treatment coverage of the whole foot. Like everyday foot garments, the conductive socks and slippers fit around the ankle and foot. TENS machine treatment can be delivered through this conductive equipment to provide a complete pain-relieving effect for your plantar fasciitis. 

 

  • Setting the TENS Mode for Plantar Fasciitis:

There are three main settings that you may be able to adjust depending on the TENS unit that you purchase, including frequency (Hertz), pulse width (microseconds) and intensity (milliamps). These can be preset or adjusted based on the type of condition you're attempting to treat. 

 

Typically, the pulse rate and frequency are set before the treatment but can be adjusted later depending on your body's response. Intensity is altered once the treatment has started. It describes how much current is delivered through the skin and determines the delivery strength. Many users will report greater sensation with higher intensity and often a more noticeable pain-relieving effect [6]. Intensity must never be so high that the treatment becomes uncomfortable or cause more pain.

There are different modes available on TENS machines, and the most appropriate one for Plantar Fasciitis depends on the individual's preferences and the severity of the condition. The most common modes are burst, continuous, and modulation. Burst mode delivers short bursts of electrical stimulation at regular intervals, while continuous mode provides a steady stream of electrical stimulation. Modulation mode varies the intensity and frequency of the electrical stimulation. It is recommended to start with burst or continuous mode, and gradually increase the intensity until a comfortable level is reached. Our Caremax 2.0 Pro model has 60 preset programs to suit your different needs. Please refer to the program card here for more details.

 

  • Setting the Pulse Rate (Frequency) for Plantar Fasciitis:

Typically, high-frequency settings (90-130Hz) provide immediate pain relief, while low-frequency treatment (2-5Hz) provides slow onset pain relief. However, research suggests low frequency settings may be more appropriate for pain relief for plantar fasciitis [7]. However, this may be adjusted depending on your preferences. 

 

  • Setting the Pulse Width for Plantar Fasciitis:

More research is needed to determine the pulse width for plantar fasciitis. Some researchers suggest that changing the pulse width is less relevant than modifying frequency and intensity settings [6]. 

 

  • How Often Should You Use Your TENS Machine for Plantar Fasciitis?

If you are unsure how often to use your TENS machine, please talk to your doctor or physiotherapist. 

 

However, 20-30 minutes of treatment is usually adequate for pain relief. Researchers who investigated electrical stimulation treatment for plantar fasciitis pain found significant improvement in pain with 20 minutes of treatment.

 

Outside of side effects or those with contraindications (detailed in the following two sections), there is no consensus about how often you can use the TENS unit [7]. However, multiple uses in a short period may lead to treatment tolerance.  

 

Using Caremax TENS machine for Pain Mangement


We provide a comprehensive packaging solution for Pain Relief. Discover the most sought-after products below essential for effective TENS therapy treatment.

 Caremax 2.0 Classic TENS machine   Caremax 2.0 Pro TENS Machine

 

 

Where and when to not use TENS machines

 

Where not to use your TENS machines [8]:

 

· Over damaged skin (e.g. wounds, cysts, skin infections, etc.)

· Areas with altered sensation

· Areas with extreme oedema 

· Areas located near cancer growths or clots

· Regions that have been radiated

· Inappropriate areas unrelated to the plantar fascia (e.g. eyes, mouth, front of the neck, genitalia, over the chest, etc.)

 

TENS machines should also not be used in specific circumstances, such as [8]: 

 

· If you have an implanted device, such as a pacemaker, neurostimulators, bone growth stimulator, etc.

· Those diagnosed with epilepsy 

· Individuals that are pregnant

· Those with cognitive or behaviour impairments

· Individuals that cannot consent to treatment

 

Are there any risks of side effects when using a TENS Machine?

 

The most common side effects of using a TENS machine are altered sensation over the areas applied and skin irritation. Significant side effects are rare and may occur when misused or for people with specific circumstances (listed above). 

 

While infrequent, more concerning side effects include:

 

· Worsening pain

· Interaction with any electronic implants

· Epilepsy

· Chest pain

· Stroke

· Clotting

· Altered blood circulation

· Fainting

· Significant skin damage

· Burns

 

If you suspect that you are experiencing any side effects, stop the treatment and consult your doctor.

 

 

References

 

  1. Rasenberg, N., Bierma-Zeinstra, S. M., Bindels, P. J., van der Lei, J., & van Middelkoop, M. (2019). Incidence, prevalence, and management of plantar heel pain: a retrospective cohort study in Dutch primary care. British Journal of General Practice, 69(688), e801-e808.
  2. Pollack, A., & Britt, H. (2015). Plantar fasciitis in Australian general practice. Australian family physician, 44(3), 90-91.
  3. Buchanan, Benjamin K., and Donald Kushner. "Plantar fasciitis." (2017).
  4. https://ankleandfootcentre.com.au/detailed-explanation-pathophysiology-plantar-fasciitis/
  5. https://www.d.umn.edu/~jfitzake/Lectures/DMED/Somatosensation/Somatosensation/GateTheory.html
  6. Watson, T. (Ed.). (2008). Electrotherapy E-Book: evidence-based practice. Elsevier Health Sciences.
  7. Stratton, M., McPoil, T. G., Cornwall, M. W., & Patrick, K. (2009). Use of low-frequency electrical stimulation for the treatment of plantar fasciitis. Journal of the American Podiatric Medical Association, 99(6), 481-488.
  8. https://www.healthcare.uiowa.edu/marcom/uihc/pain_medicine/contraindication_precautions_best062018.pdf