Easing Pain from Plantar Fasciitis Without Surgery

 
 

Bad news: Plantar Faciitis is painful. Good news: it does not always require surgery.

Let's talk about what we can do to treat the condition without having to dip into our surgical toolbox.

SYMPTOMS  of plantar Fasciitis

Patients with plantar fasciitis have symptoms on the plantar surface of the foot or the bottom of the heel.

The classic symptom of plantar fasciitis is when the first few steps out of bed are painful.

The pain can be dull and aching, or excruciating to the point of causing someone to hobble or consider crawling their way to the bathroom. “Symptoms typically ease up after the first few steps but for someone who stands a lot or does a lot of activity they can actually get worse.

Who Is At Risk for plantar fasciitis?

Patients who are at risk for plantar fasciitis often have a tight Achilles tendon or spend a lot of time on their feet. They are runners or folks who maybe have gotten a little overweight.

The disease typically affects just one side, but it can occur in both feet.

What's The Plantar Fascia?

The plantar fascia is a thick band of tissue that attaches to the heel bone and runs underneath the foot all the way out to the toes.

There can be some associated inflammation but the condition is primarily a degenerative condition of the plantar tissue that results from repetitive stress injury or aging.

Bone spurs often form at the attachment site of the plantar fascia to the heel but are generally not considered to be the cause of the condition.

TREATMENT OPTIONS

The typical non-surgical treatment for plantar fasciitis is multi-faceted and tailored to the individual patient. The physical exam patient history and x-rays will determine which regimen will be most effective.

Non-Surgical Treatment Options

Non-surgical treatment may include some or all of the following:

  • stretching and strengthening exercises

  • physical therapy supportive footwear

  • anti-inflammatories orthotics

  • heel cups and a night splint to keep the Achilles tendon and plantar fascia stretched out throughout the night.

Dr. Elton says surgery is rarely needed for treating plantar fasciitis. About 90 percent of people will get better with non-operative options after about 6-10 months of treatment. “This can be particularly trying for active patients who don't want to put their activities on hold for such a long time” Elton says.

Second Line Treatment Options

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Second line treatments for someone who isn't getting better after trying these initial treatments might be candidates for shock wave therapy or steroid injections.

Like most orthopaedic treatments there's not one treatment regimen that works for all people. We tailor the treatment plan for each patient.”

But there are those extreme cases where surgery does become necessary. And when that happens, there are a couple different surgical options for treating plantar fasciitis. “The classic approach is to make an incision to expose the plantar fascia and remove the diseased part. At the same time we are releasing the nerve that's getting pinched.”

A Procedure To Avoid Surgery

However, there is a new minimally invasive procedure for certain patients. “

With the minimally invasive technique, we:

  • Make a tiny incision just over the heel.

  • An ultrasound device is used during the procedure to identify the exact location of the diseased tissue.

  • We insert a small device that simultaneously breaks-up and removes the diseased tissue.

The procedure can be performed in about 15 minutes with local anesthetic.” Patients can walk on the foot immediately and most patients return to full activities within four to six weeks.

I want to point out that not all patients are candidates for minimally invasive treatment because some will have related nerve irritation or severe Achilles tightness that may require a separate procedure to correct.

The most important thing when treating plantar fasciitis is to not give up! “Be patient and remember that things will get better.”