Plantar Fasciitis
Plantar Fasciitis
Plantar fasciitis is one of the most common conditions seen in our office and is the most common reason for heel pain. There are other causes of heel pain (stress fracture, nerve entrapment, tendonitis, arthritis, cyst) so it important that a proper diagnosis be made from the onset.
The plantar fascia is a band of tissue that runs from the heel, spans the entire bottom of the foot, and inserts into the forefoot. The function of the plantar fascia is to support the arch of the foot. As one walks, the plantar fascia contracts and stretches. But with certain predisposing factors, such as flat feet, high arched feet, weight gain, prolonged walking, poor fitting shoes, and minor trauma, the plantar fascia may undergo extreme stress resulting in inflammation. Plantar fasciitis then, is the inflammation of the plantar fascia tissue, which occurs mostly at the insertion point on the heel but can occur anywhere along the tissue.
The symptoms of plantar fasciitis usually consist of pain in the bottom of the heel, pain with prolonged walking/ activity, and pain with “first step” in the morning or after prolonged sitting that gets relieved with some walking. The theory behind the “first step” pain is that with inactivity, the plantar fascia contracts and overly tightens which then causes a severe stretch or tearing with the first steps. As one walks it off, blood flow improves to the area and the plantar fascia undergoes a therapeutic stretch.
The diagnosis is usually made with history and physical examination. We may take x-rays or ultrasound to rule out stress fractures and nerve entrapments, which at times may mimic plantar fasciitis. Sometimes heel spurs may be seen on diagnostic images but rarely is it a source of pain, contrary to most people’s beliefs.
Conservative
treatment consists of icing/ stretching exercise, shoegear modification, anti-inflammatories, over the counter insoles (only the ones dispensed at a podiatrist’s office is recommended), custom orthoses, weight loss, night splints, and immobilization with a CAMwalker. The most effective treatment though has been cortisone injections to the heel area. The direct effect of cortisone to the heel area usually causes immediate decreased inflammation and thus, immediate relief of pain. Cortisone acts effectively to solve the problem and not “mask” the problem, as some would believe.
If conservative treatment fails, which is less than 5% of the time, we do perform endoscopic plantar fasciotomies. The surgery is a minimal incision surgery. A small incision (1 mm) is placed on both sides of the heel. One incision is used as a portal for a small camera while the other incision is used as a portal for a blade. We then proceed to cut half of the plantar fascia near it’s insertion which would then stretch the tissue resulting in reduced tension at the insertion point, the heel.
The surgery would be performed as an outpatient surgery at a hospital or surgery center. The patient would be placed under IV sedation and the procedure usually lasts about thirty minutes. Only a few stitches would be needed to close the wound since this is a minimal incision surgery. A dressing is placed on the incision site and the patient is given a CAMwalker boot to walk home with.
Post-operatively, the patient is seen back at our office every 1-2 weeks to ensure proper healing is taking place. Usual healing time is 4 weeks, but the patients may start walking with a CAMwalker boot on their new foot the very next day. The CAMwalker is worn for two weeks and the stitches are removed in two weeks. Dr. Baik believes that early range of motion to the surgery site actually improves healing time by improving circulation, reducing scar tissue, and preventing muscle atrophy.