Plantar Fasciitis

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:

• Bracing/Orthotics - Wearing firm shoe gear and supportive inserts called orthotics are a very important aspect of improving and maintaining pain-free ambulation. The vast majority of patients actually require a more rigid or firm orthotic to help support the plantar fascia to help decrease the strain on the ligament.
• Anti-inflammatory medications
• Steroid or “cortisone” injections into the plantar fascia can reduce inflammation and reduce pain associated with the plantar fasciitis.
• Calf stretching exercises - Decreasing the forces from a tight calf muscle is key. Calf stretching exercises should be done on a daily basis.
• Night splints - Help improve flexibility of the calf muscles
• Physical Therapy
• CBD – CBD is a natural, nonsurgical way to help treat Musculoskeletal related pain and inflammation
• PRP and Stem Cell injections are nonsurgical ways to treat pain and inflammation associated with plantar fasciitis.

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.