Dr. Reza Mobarak, Southwest Foot and Ankle Center
Plantar fasciitis is a painful inflammatory process of the plantar fascia. Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis. The plantar fascia is a thick fibrous band of connective tissue on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. It is associated with long periods of weight bearing.
The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot, so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom recognized among sufferers of plantar fasciitis is increased probability of knee pains.
Diagnosis
The diagnosis of plantar fasciitis, is usually made by clinical examination. The examination may include checking the patient’s feet and watching the patient stand and walk. The examination will take under consideration a patient’s medical history, physical activity, foot pain symptoms and more. The doctor may decide to use imaging studies.
A finding associated with this condition is a heel spur, a small bony calcification, on the calcaneus heel bone, in which case it is the underlying condition, and not the spur itself, which produces the pain. The condition is responsible for the creation of the spur, the plantar fasciitis is not caused by the spur.
Sometimes ball-of-foot pain is mistakenly assumed to be derived from plantar fasciitis. A dull pain or numbness in the metatarsal region of the foot could instead be metatarsalgia, also called capsulitis.
TREATMENT
Medical
Orthotics, i.e., foot supports, are the only non-surgical therapy to have been supported by studies rated by the Center for Evidence-Based Medicine as being of high quality. Landorf et al. performed a single-blind experiment in which patients were randomly assigned to receive off-the-shelf orthotics, personally customized orthotics, or sham orthotics made of a soft, thin foam. Patients receiving real orthotics showed significant short-term improvements in functionality compared to those receiving the sham treatment.
Pain with the first steps of the day can be reduced by stretching the plantar fascia and Achilles tendon before getting out of bed. Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease pain on waking.
To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen, are often used.
Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, especially if not combined with a local anesthetic and injected slowly with a small-diameter needle.
There is a new treatment of plantar fasciitis which is non-surgically based, very effective, and usually done within the clinical setting. This is called the PRP treatment. Plasma is what’s left when blood cells are separated from the liquid component of human whole blood. The plasma portion contains numerous biologic factors that have been shown to enhance healing in studies.
Surgery
Surgery carries the risk of nerve injury, infection, rupture of the plantar fascia, and failure to improve the pain. Traditional surgical procedures, such as plantar fascia release, are a last resort, and often lead to further complications, such as a lowering of the arch and pain in the supero-lateral side of the foot due to compression of the cuboid bone. This will allow decompression of the nearby FDB muscle belly that is inflamed, yet doesn’t fix the underlying problem. This basically allows more space for the inflamed muscle belly, thus, relieving pain/pressure. Ultrasound guided needle fasciotomy can be used as a minimally invasive surgical intervention for plantar fasciitis.
Coblation surgery (aka Topaz procedure) has been used successfully in the treatment of recalcitrant plantar fasciitis. This procedure utilizes radiofrequency ablation and is a minimally invasive procedure.
Dr. Reza Mobarak heads the Southwest Foot and Ankle Center with offices in Plano and Lewisville and may be reached at 972-316-0902. www.swfacenter.com
