Plantar fasciitis is a common condition affecting millions of American each year. The condition is marked by inflammation and/or micro-tearing of the plantar fascia, which is a broad ligament on the bottom (plantar) aspect of the foot. The plantar fascia stretches from the toes along the arch back to its insertion at the heel.
When you stand, the arch of the foot flattens slightly, putting a stretch or tension on the plantar fascia. When the attachment of the plantar fascia on the bottom of the heel becomes inflamed or injured, this is known as insertional plantar fasciitis (the most common type). Irritation or injury along the broad surface of the plantar fascia in the arch is known as diffuse plantar fasciitis.
Both types of irritation cause pain in patients’ feet and heels, particularly when the patient stands up during the day or initially wakes up in the morning.
Causes of plantar fasciitis are many. They include:
Note that not all heel pain is plantar fasciitis. Other conditions that may produce heel pain include:
Diagnosing plantar fasciitis starts with a careful examination and discussion of a patient’s history, which will often highlight telltale signs of the condition.
Symptoms revealed in a patient’s history include:
The examination itself often reveals exquisite tenderness at the medial insertion of the plantar fascia. Often the Achilles tendon is also tight to the touch.
An exam must also rule out other causes of foot and heel pain:
Treatment of plantar fasciitis initially begins with conservative action.
Multiple studies and (Dr. Bowman’s own personal experience) have revealed that 99% of patients can be successfully treated without surgery. Pittsburgh Foot & Hand Center has also enjoyed great success with our comprehensive conservative program to treat plantar fasciitis over the years. It consists of:
Even if you have tried these techniques in the past, we ask that you use them together per our specific treatment plan recommendations before giving up on your recovery
For patients with persistent plantar fasciitis, additional treatments may be utilized.
We are currently pioneering a new treatment for plantar fasciitis involving the use of platelet-rich plasma (PRP). In this situation, approximately 30 cc of blood is drawn from the patient, prepared in the special centrifuge, and the buffy coat-part of the plasma (containing platelets together with human growth factors) is obtained. That is then injected into the area of inflammation to promote healing. This new in an exciting treatment may develop into the common method of treatment.
Surgery may be required for cases of plantar fasciitis that do not respond to the above nonsurgical treatments. This approach should be utilized less than 1% of the time.
If needed, the surgery is performed on an outpatient basis with twilight local standby anesthesia. A small incision is made on the plantar heel, just in front of the main weight-bearing area of the heel. The medial one-third of the plantar fascia is released and the skin is closed.
Patient's are placed in a protective boot post-op with no weight-bearing allowed for two weeks. At the two-week visit, the sutures are removed and progressive weight-bearing exercises are begun (together with initial therapy) to help restore range of motion.
At 6 weeks the patient is placed back in their normal shoes with orthotics.
Surgical risks with this condition and surgery include anesthesia-related risks, wound healing problems, infection, painful plantar incision, and continued post-op discomfort.
Note that "Endoscopic" (one or two incision variations) for this procedure have been utilized elsewhere. Because of difficulty controlling the amount of plantar fascia release and permanent damage to the plantar nerves, we do not utilize this procedure. Unfortunately, we have inherited patients with both of these complications from elsewhere.