Plantar Fasciitis

Plantar fasciitis is the most common reason for pain on the bottom of the heel. It occurs when the plantar fascia (the flat ligament that runs between the heel and the foot pad on the bottom of the foot) is strained, develops tears, and becomes inflamed. The resulting heel pain can range from very light to very debilitating. Most people suffering from plantar fasciitis will be relieved of symptoms within a year of non-surgical treatment. Surgery is usually needed for only one out of every 20 patients.

Although plantar fasciitis generally develops without an identifiable cause, there are personal factors that can lead to the condition. They include being obese, having a very high arch, participating in repetitive impact activities, starting or increasing activities, or experiencing difficulty flexing a foot and bringing the toes toward the shin due to having tighter calf muscles.

Symptoms that you might tell your JOI Beaches physician about include pain on the bottom of the foot near the heel, pain with the first few steps after a long period of rest that subsides after walking a bit, and increased pain after an activity or exercise. Your doctor will check for a high arch; an area just in front of the heel bone that has extreme tenderness; pain that worsens when pushing on the plantar fascia or flexing the foot; pain that improves when the toes are pointed down; and a limit to the “up” motion of the ankle. Before prescribing treatment, the doctor may order x-rays to rule out other causes of heel pain.

After a diagnosis of plantar fasciitis, non-surgical treatment is initially prescribed. It may include one or more of the following:

  • Rest – Limit the amount of time spent on your feet in order to reduce pressure on the heel.
  • Ice – Ice your heel for 20 minutes, three to four times a day.
  • Nonsteroidal anti-inflammatory medicine – Ibuprofen, naproxen, and aspirin should be taken per doctor’s orders.
  • Exercise – Strengthen the muscles around the arch by doing stretches to loosen up the muscles and ligaments.
  • Orthotics and supportive footwear – Thick-soled shoes and inserts or custom orthotics reduce tension and trauma. Soft heel pads elevate and cushion the heel.
  • Cortisone injections – The steroid is injected into the plantar fascia to reduce pain and inflammation. Treatment is limited. Over-administration can cause the plantar fascia to tear, resulting in a flat foot and chronic pain.
  • Night splints and walking casts – During sleep, a night splint stretches the plantar fascia by positioning the foot at a 90-degree angle to the ankle. It holds the toes in an upward position to maintain a constant, light stretch. It does not have to be used once the pain is gone. Another device is the walking cast. A walking cast holds the foot in place for several weeks. Physical therapy to restore flexibility may be necessary after the cast is removed.
  • Physical therapy – Your doctor might suggest working with a physical therapist on a guided exercise and rehabilitation plan. It should always be tried before choosing the option of surgery.

If non-surgical treatment is not successful after 12 months, surgical treatment may be necessary.  Surgical procedures include:

  • Gastrocnemius recession – A surgical lengthening of the calf muscle, this procedure is for patients who continue to have difficulty flexing their foot. It can be performed with an open incision or with a smaller incision and an endoscope. Complications are usually minimal, but can include nerve damage.
  • Plantar fascia release – Part of the plantar fascia ligament is cut to release tension and relieve inflammation. The procedure is for patients having continued heel pain but normal range of ankle motion. It can be performed with an open incision or with a smaller incision and an endoscope. General complications may include nerve entrapment or tarsal tunnel syndrome, development of a neuroma, constant heel pain and swelling, infection, long recovery time, and delayed ability to heal the wound. Endoscopy is more difficult and less preferred than open surgery. It has a higher risk of damage to the small nerves in the foot. \
  • Tenex FAST – This minimally invasive procedure identifies and removes pain-generating scar tissue from tendons in the foot. The scar tissue can be due to plantar fasciitis. After it is inserted into the affected area, the micro tip of the TX1 tissue removal system releases ultrasonic energy. The ultrasonic energy breaks and emulsifies the scar tissue. The scar tissue is aspirated and the opening is covered with an adhesive bandage. Tenex FAST is a safe alternative to open surgery.

For most people, results are usually good after surgery. Nonetheless, a surgical procedure is recommended only after all non-surgical treatments have failed.

If you are feeling any type of heel pain or discomfort, please schedule a consultation at Jacksonville Orthopaedic Institute Beaches. One of our highly-skilled surgeons will be happy to discuss your pain, your lifestyle, and the steps necessary to ensure that you are back to your best self. Contact us today at 904-241-1204.


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