Plantar Fasciitis

Are you having pain in your heel with walking? Feel like you’re walking on a stone? Pain on the bottom of your foot with activity? You may have a syndrome called Plantar Fasciitis.

Plantar Fasciitis: What is it?

Plantar Fasciitis is a diagnosis given to patients with pain in the heel near the plantar fascia insertion. It is often times referred to as “heel spur syndrome” because a heel spur can often be seen along the bottom of the calcaneus or heel bone on X-ray.

Symptoms: What does it feel like?

Most people with plantar fasciitis complain of pain along the bottom of the heel. The pain is often with the first steps in the morning or after a period of rest. It usually subsides after a period of walking but can get worse again after exercise or a period of increased activity.

Causes

Many cases of plantar fasciitis develop without any specific or identifiable reason. There are some risk factors, however, that lead one to be more prone to plantar fasciitis. For example, tight calf muscles, obesity, very high arches, and repetitive impact loading exercises can exacerbate the plantar fascia inflammation. The actual ideology of this condition is inflammation along the plantar fascia, which is a fibrous band of tissue that inserts into the heel bone. This irritated and inflamed tissue is painful when pressure is applied.

Evaluation: How is Plantar Fasciitis diagnosed?

Typically the diagnosis is determined by your history and physical examination. Tenderness along the heel bone is the most consistent exam finding. High arches and limited ankle range of motion can often be identified.

Radiographs (X-rays) are usually obtained. A heel spur along the bottom of the calcaneus (heel bone) is often noted. However, 1 out of 10 people have heel spurs on X-ray, but only 1 out of 20 people, or 5%, actually have heel pain.

Treatment

More than 90% of patients with plantar fasciitis will improve with active conservative measures, although it may take several months. Rest or decreasing the activity that might be aggravating the pain is the first step. Ice and activity modification is often helpful. A night splint designed to stretch the plantar fascia and Achilles tendon complex is often worn. Supportive shoes and shoe inserts (custom orthotics) can add cushion to the heel and help limit the strike on the plantar fascia during normal gait. Often times and inexpensive, off the shelf silicon heel pad can be enough to reduce the pressure. Physical therapy can help if the home stretching program is not enough. A corticosteroid, a type of steroid, is a powerful anti- inflammatory medication, and can be injected into the plantar fascia to reduce the inflammation and pain. Multiple cortisone injections however, can lead to atrophy of the heel pad and possible rupture which we try to avoid. Non-steroidal anti-inflammatory medications, such as Ibuprofen and Naprosyn, can also reduce inflammation. Extra corporal shock wave therapy (ESWT) is a high energy shock wave impulse that can sometimes help heal the damaged tissue. It leads to “neovascularization”, or new blood flow, into the planar fascia which can aide in healing. Surgical options are typically left for patients that fail active conservative treatment over an extended period of time. A surgical option, in some patients, involves releasing the gastroc muscle fascia, if it is felt to be tight, to improve ankle range of motion. This also can improve the heel pain in those select patients. Plantar fascia release is also a surgical option to ease pain, where the actual plantar fascia tissue is partially cut. The downside to cutting the plantar fascia is incomplete pain relief and possible nerve damage. The TOPAZ procedure, involves using a micro-debrider, a form of bipolar plasma-media technology for controlled debridement of soft tissue along the plantar fascia insertion. This is a minimally invasive outpatient procedure that can also try to improve the healing potential of the plantar fascia and improve pain.

Recovery: What Can Be Expected?

Most plantar fasciitis is improved with conservative measures avoiding surgical intervention. It often times takes many months, but will typically improve slowly. If a procedure, such as the TOPAZ or ESWT is performed, typically patients are walking right away and can anticipate pain relief with 6 to 8 weeks.

Frequently asked questions about Plantar Fasciitis

Physicians

The following physicians specialize in the treatment of Plantar Fasciitis:

Eric S. Watson, MD

Dustin P. Collins, MD

Gregory M. Neely, MD

Gregory F. Alvine, MD

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Testimonials

I went to Dr. Watson with a lot of foot pain. He guided me through the process of healing. His office is connected with great physical therapists that were able to assist me in buying the correct shoes and orthotics. They made a great team in helping me walk comfortably again. I was happy to avoid surgery.

I had similar surgery on my other ankle several years ago with another doctor so I was hesitant going into this surgery but this went a 100 times better. Very pleased so far with the results and he and his whole staff are outstanding.

I broke my lower leg bone in my ankle on Saturday, Dr. Watson was able to see me on the following Monday. I had my surgery the next day. I have been more than happy with Dr. Watson and his staff. I was able to have open discussions about what to expect and how the treatment will go. I have nothing but positive testimonials for the service I’ve received. I highly recommend Dr. Watson and his staff. Top notch!

Plantar Fasciitis