Plantar Fasciitis


Plantar fasciitis is the most common cause of heel pain, affecting 2 million Americans each year, and it is the most frequent patient diagnosis for many podiatry offices. Some doctors will also refer to it as heel spur syndrome. Plantar fasciitis ("itis" = inflammation) is caused when increased tension on the plantar fascia causes pain and inflammation. Plantar fasciitis can affect both men and women regardless of activity level, shoe selection, or foot type. Luckily, plantar fasciitis rarely leads to surgery, and most patients will notice some level of relief shortly after the first appointment.

Anatomy

The Plantar Fascia is a ligament that connects the heel bone (calcaneus) to the ball of the foot. The purpose of the fascia is to hold up the arch. During standing and walking, the arch naturally collapses a little, which causes the plantar fascia to stretch. If the plantar fascia is too tight, that additional stretch can cause pain and inflammation, most commonly where it attaches to the calcaneus. Tightening of tendons and ligaments occurs naturally, over time, but certain activities and shoes can increase this process.

In addition, part of the plantar fascia wraps around the back of the heel bone, directly connecting with the Achilles tendon. Contracture of the Achilles tendon, also called "Equinus", is a common condition that has been reported in up to 96% of patients with foot pain and up to 50% of patients without any symptoms. The presence of equinus can place twice the amount of strain on the plantar fascia as normal body weight. This has lead researchers to discover that up to 83% of patients with plantar fasciitis have an associated equinus deformity.
 

Evaluation

Diagnosis of plantar fasciitis can be accurately made off a good clinical history and physical examination. X-rays are routinely taken to rule out a stress fracture or bone cyst, as well as to assess foot structure. Diagnostic Ultrasound is extremely useful is diagnosis, as it can help measure the amount of inflammation present in the plantar fascia. Ultrasound can also help to rule out a rupture of the fascia.

Symptoms of Plantar Fasciitis:

  • Pain in the morning, with the first steps out of bed
  • Pain at the end of the day, with the first steps after sitting down or rest
  • Sharp or Stabbing pain on the bottom of the heel or in the arch
  • Pain may decrease after "warming up" with some walking or standing
  • Pain may decrease when wearing a higher heel shoe
Plantar Fasciitis

Treatment

As mentioned above, treatment for plantar fasciitis is non-surgical in more than 95% of cases. The key to successful treatment is good patient education, as most of the treatments will be performed by the patient outside of physician supervision.

When treating plantar fasciitis, you are actually treating two things:

  1. You are treating the inflammation, and pain, associated with fasciitis.
  2. You are treating the tightness in the plantar fascia, and Achilles tendon, that started the inflammation in the first place

It is important to focus on both aspects of treatment, as neglecting the latter is the most common reason for treatment failure and recurrence. Non-Surgical treatments for plantar fasciitis try to accomplish three necessary goals for success.

Decrease Inflammation:

  • Ice
  • Anti-Inflammatory Medication
  • Steroid Injection
  • Topical Compounded Cream

Increase Flexibility:

Increase Arch Support:

  • Strapping or Taping Arch
  • AirHeel Support Brace
  • Prefabricated Orthotics
  • Custom Orthotics

 

Additional treatment options can include Platelet Rich Plasma (PRP) injections, Extracorporeal Shock Wave Therapy, and Stem Cell Injections. While these therapies can be provided, they are rarely necessary, and they are rarely covered by insurance, which can dramatically increase the cost of treatment. 

Surgery is rarely indicated for the treatment of plantar fasciitis, but there are some instances, less than 5%, where patients do not respond to non-surgical treatments. Of these cases, surgery has an approximate success rate between 80% and 90%. Traditional surgery involved making an open incision and releasing 50% or more of the plantar fascia. Success rates are high, but return to normal activities can take 12 weeks or more. Utilizing Minimal Incision Surgery, through Percutaneous Topaz Radiofrequency Ablation or Endoscopic Fasciotomy, Dr. McSpadden can offer a surgical solution that has equivalent success rates, while cutting the recovery time in half!

If you are suffering from Heel Pain or Plantar Fasciitis, Call us at 512-593-2949 or CLICK HERE to Schedule an Appointment.