This is the most common foot problem I see in my practice.
Plantar fasciitis (or more appropriately coined “fasciosis”) is an overuse syndrome of a large ligament that spans the undersurface (plantar) foot. The ligament spans from the heel bone and eventually fans out into five separate ligaments, each of which will attach to all five toes. Plantar fasciosis will present with pain isolated to the plantarmedial (bottom and inner) aspect of the heel. Pain is typically worse after periods of rest. Commonly, patients will complain of significant pain with first steps in the morning. This is known as “post-static dyskinesia”. Pain will subside with some activity but can worsen as activity persists throughout the day.
What aggravates plantar fasciitis?
Plantar fasciitis is aggravated by excessive activity. This can cause the inflammation and irritation of the plantar fascia. Inadequate rest can also aggravate the condition as it prevents the plantar fascia from healing properly. Improper shoes that lack support can also aggravate plantar fasciitis. This is because they do not provide the necessary support for the foot, putting additional strain on the plantar fascia. As a result, it is important to select shoes that offer adequate support to help prevent plantar fasciitis.
Conservative treatments for plantar fasciitis pain
I always recommend non-operative treatments as the frontline option for all my patients. Examples include initial diagnostic evaluation, to include imaging as needed (digital radiography/x-ray, MRI, Ultrasound), cortisone injections, orthotic fabrication, splinting, immobilization, physical therapy referrals, shoe gear evaluation.
I also offer advanced solutions for plantar fasciitis including radial shockwave treatment, and PRP injections. These options represent the most contemporary of treatments.
Surgery for plantar fasciitis pain
Surgical management of plantar fasciitis pain is offered as a last resort and there are a handful of surgical options available. The classic approach is to perform a procedure called a plantar fasciotomy. This involves an incision placed over the fascia, and a scalpel is then used to surgically cut the fascia. I have not been impressed with the outcomes of this procedure and the medical literature has started to favor other modalities. A plantar fasciotomy can cause multiple post-operative problems including change in foot architecture (the plantar fascia is the most improve dynamic stabilizer of the arch), lateral heel pain, calcaneocuboid syndrome, among other issues.
A very frequent finding of plantar fasciitis, among other foot pathology, is a tight achilles tendon. In medical terminology, this is known as equinus deformity. Having equinus deformity means your achilles’ tendon is effectively too short which places increased stress across the ligaments of the bottom of the foot, including the plantar fascia during a critical point of the gait (walking) cycle.
Gastrocnemius recession procedure for plantar fasciitis
Surgical lengthening of the Achilles tendon by means of a gastrocnemius recession reduces stress on the plantar ligaments including the plantar fascia. My procedure of choice is called the Baumann gastrocnemius procedure as this addresses the tight heel cord within the muscle, which helps prevent weakening of the achilles tendon, which is not desirable for the active/athletic population. This also lowers the risk of inadvertent rupture of the achilles tendon, which is essentially impossible with the Baumann procedure.
The procedure must be done in the operating room under sterile conditions with sedation or general anesthesia for patient comfort. The post-operative recovery, generally speaking, involves no weight being placed on the foot for approximately 1-2 weeks. Weightbearing is then advanced to full weight on the operative extremity at that time using a special recovery boot called a CAM boot. The boot is typically discontinued approximately 3-4 weeks after surgery. Although this recovery is relatively straightforward, it does take considerably longer for the fascia to recover in the order of 2-3 months. In rare instances, some patients do not have complete resolution of their symptoms following surgery.
As you can see, many options are available for this very common foot condition. I recommend booking an appointment to have a specific treatment plan tailored for your specific situation. My goal is to come up with a plan tailored to your medical needs, but also taking your personal and athletic goals into consideration.