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Plantar Fasciitis (Heel Pain)
What is it & What's the cause?

The plantar fascia runs the length of the sole of the foot and functions to assist in maintaining its inner arch; like a thick rubber band.

Plantar fasciitis is an inflammation of the origin of the fascia at the calcaneus (heel bone). Common causes are flatfeet, repetitive strain, sports injury and wrong footwear. Typical symptoms are localized mechanical heel pain, pain after prolonged standing and taking the first few steps in the morning.

Are heel spurs the cause?

Heel spurs have long been associated with heel pain. However, heel spurs are usually the result, and not the cause of heel pain associated with plantar fasciitis. They form because of the local inflammation in the soft tissue, with the body forming bone mistakenly in its attempt to repair the plantar fascia.

plantar fasciitis

Non-Operative Management

Initial management of plantar fasciitis involves a multi-modal non-operative approach. For 80-90% of people, this is all that is required. Statistically 85% of patients get better by 6 weeks using a structured rehabilitation protocol.

These include,

  1. Anti-inflammatory medication
  2. Rest from activity, calf and plantar fascia stretching exercises
  3. Extracorporeal shockwave treatment (ESWT)
  4. Custom insoles including appropriate foot wear
  5. Corticosteroid injection
Silicone heel cups
Calf muscle stretching exercise with the Achilles heel. Plantar fascia stretch (upward and downward movement of the big toe) done in a seated position while massaging the affected painful area
Corticosteroid Injection
Shockwave therapy to the heel
Minimally Invasive Management Options

A very small group of patients may have ongoing pain despite adequate non-operative management. Chronic plantar fasciitis is pain that persists beyond 3 months. These group of patients usually have a chronic plantar fascial tear or scarring that may need further investigation and intervention.

There are several office procedures that can be done for plantar fasciitis.

  1. Topaz debridement with a wand. This is done to promote organised soft tissue healing.
  2. Injection of platelet rich plasma (PRP). This is where the blood from the patient is obtained, spun and the plasma component of the blood is separated out. This plasma that is separated contains growth factors and proteins. This is then injected into the plantar fascia to promote healing of the tissue.
Platelet rich plasma ( PRP) samples separated from the blood
Topaz microdebridement
Surgical Options

Surgery for plantar fasciitis is uncommon and its indicated in less that 10% of patients. Rarely it is indicated in conditions where there is a plantar fascia tear or in a patient with flatfeet that are not responding to insoles. Sometimes patients have calf muscles that are very tight.

Some of the procedures include:

  1. Correction of the flatfeet using an internal orthotic stent. The procedure is called Extra Osseous Tarsal Tunnel Stabilization (EOTTS). This is done to reduce the strain on the plantar fascia at the insertion onto the heel, the pronation is corrected with EOTTS procedures relieving the plantar fascia strain.
  2. Release of the calf gastrocnemius fascia. This is done to free the tension on the calf muscle so that the loading on the heel is less.

The above procedures are minimally invasive procedures done with keyhole techniques as aday surgery. The patient walks home same day and begins a protocol of physiotherapy the very same week.

plantar fasciitis8

It is best to consult a foot & ankle specialist surgeon if the pain persists to avoid missing more serious injuries like a calcaneus stress fracture or a plantar fascia tear. This is a condition that can be easily treated.

ask our orthopaedic surgeon

If you would like to find out more details about bunion, please use the enquiry form below to ask our orthopaedic surgeon, Dr K Kannan. You may attach medical reports on the enquiry form as well.

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