Plantar fasciitis is a very common injury that happens within the foot and ankle. It is the most common cause of heel pain. It affects approximately 2 million people a year. It is caused by inflammation of a strong band of tissue, called a ligament, on the bottom of the foot.
While we encourage you to attempt conservative care at home, delayed care will reduce the efficacy of conservative care. Do not continue to suffer from heel pain, call today to schedule your consultation to meet with a foot and ankle specialist at Central Florida Bone and Joint Institute.
The plantar fascia is a strong band of tissue, called a ligament, it runs from the heel bone and extends to the ball of the foot. This ligament is a strong supporter of the arch.
Plantar fasciitis is caused by repetitive micro trauma to the insertional point of the plantar fascia. With increased activity and unsupportive shoe gear the plantar fascia incurs increased stress resulting in inflammation. In general, the most common causes of plantar fasciitis are a combination of multiple factors which includes but are not specific to: increases in activity, tight calf muscles, unsupported arch, and increases in patient's weight.
The most common symptom of plantar fasciitis is a sharp pain in the bottom of the heel bone, which is most common when the patient stands after periods of prolonged rest. Very commonly patients state their pain is worse first thing in the morning when they get out of bed. Symptoms appear to improve slightly after a few steps, but does not resolve completely. Pain can occur at any location on the plantar fascia but most commonly it located at the insertion of the plantar fascia to the heel bone.
The diagnosis of plantar fasciitis is most commonly a clinical diagnosis, which is achieved by a thorough discussion and physical examination by a foot and ankle specialist. Other modalities will be utilized to help diagnose plantar fasciitis. X-rays will be done in the office. Although the plantar fascia is not able to be completely evaluated with an x-ray, it will allow for your provider to see if a bone spur has formed or if there is any other acute pathology. Heel spurs will quite commonly be seen in patients with plantar fasciitis but the spur itself does not cause the heel pain. The heel spur forms over time due to repetitive stress on the insertion of the plantar fascia to the heel bone. Ultrasound is helpful to evaluate the overall thickness of the plantar fascia as well as surrounding inflammation consistent with plantar fasciitis. In patients that continue to not respond to conservative treatment, an MRI can be ordered for further diagnosis.
Although heel pain and plantar fasciitis are very common, patients normally respond very well to conservative treatment, with 90 to 95% of patients improving with conservative care. Conservative care consists of reducing inflammation and removing the stress from the plantar fascia. This is achieved using the following methods:
In a small percentage of patients that do not respond to conservative treatment surgery is required. When surgery is required two main procedures are utilized. A partial release of the plantar fascia is the most common and effective way of treating chronic nonresponsive plantar fasciitis. The foot and ankle experts at Central Florida Bone and Joint Institute use a minimally invasive technique to release part of the plantar fascia. Two small incisions are made on either side of the heel and a small camera is inserted in the bottom of the foot so the ligament is visualized and a portion of the plantar fascia is released to decrease the tension on the plantar fascia. Minimally invasive arthroscopic techniques aid in quicker recovery and pain relief. Less commonly in patients with very tight calf muscles a gastrocnemius recession is sometimes utilized to help further reduce the chances of recurrence and decrease the strain on the plantar fascia. In this procedure part of the Achilles tendon is lengthened thru a small incision on the back part of the leg.
**Disclaimer: Treatment recommendations may vary depending on your true diagnosis. Always follow the recommendations of your orthopedic provider.