Plantar Fasciitis

When plantar fasciitis occurs, the plantar fascia first becomes irritated and then inflamed. When there is inflammation, it can cause stabbing pain in your heel and discomfort with long periods of standing. Plantar fasciitis is a common cause of heel pain. 

At OrthoMed, our board-certified orthopedic foot and ankle surgeon, Dr. Braaton, sees patients with plantar fasciitis quite frequently. We offer both nonsurgical and surgical treatment options for plantar fasciitis.

You may be more prone to developing plantar fasciitis if you

• Have overly flat feet or high-arched feet
• Wear non-supportive footwear on hard, flat surfaces for extended periods of time 
• Are obese 
• Participate in repetitive high-impact activity (running/sports) 
• Start a new activity or increase activity

The symptoms of plantar fasciitis include:

• Pain on the bottom of the heel
• Pain in the arch of the foot
• Pain that is usually worse upon first standing from rest
• Pain that increases over a period of months
• Tight calf muscles, which make it difficult to flex the foot fully and end up shortening the plantar fascia over time

Many patients describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. And even though the pain decreases after a few minutes of walking because walking stretches the fascia, the pain returns after spending a long time on their feet.

During your consultation at OrthoMed, Dr. Braaton will ask you to describe your symptoms and discuss your concerns. He will also examine your foot for any signs that are consistent for the diagnosis of plantar fasciitis, such as:

• High arches
• Tenderness around your heel
• Pain when you flex your foot, and the doctor presses down on the plantar fascia    
• Limited “up” motion of your ankle

Imaging tests, such as x-rays, are useful to ensure your heel pain is caused by plantar fasciitis and not some other conditions, such as a fracture or arthritis.

Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not generally ordered for plantar fasciitis; however, if initial treatment methods do not relieve your heel pain, the doctor may order an MRI scan for further evaluation of your problem.

In most cases, conservative treatment works well for plantar fasciitis, and the condition will resolve in 12 to 18 months. However, surgical options are also available if conservative treatments have not been effective.

Conservative treatment for plantar fasciitis involves using a night splint to hold the foot in an extended position while the patient sleeps. This can help to alleviate the heel pain usually experienced in the morning. Shoe inserts or custom orthotics may also be recommended to help cushion the heel and reduce heel pain experienced while standing or walking. Additionally, topical or oral anti-inflammatory medications may also help to improve heel pain throughout the day.

Physical therapy can be quite beneficial as well for patients with plantar fasciitis. Physical therapy can focus on stretching the plantar fascia and calf muscles, thus lengthening the tissue and improving range of motion.

More aggressive treatment options may be recommended if conservative solutions are not successful in relieving pain. The latest treatment options for plantar fasciitis are minimally invasive and can help patients avoid or delay the need for traditional surgical intervention.

Platelet-rich plasma injections are thought to stimulate healing in the plantar fascia because platelets contain proteins called growth factors that are integral to the healing process. During this procedure, the patient’s blood is placed in a centrifuge to separate the platelets from the blood cells. The highly-concentrated platelets are then injected into the injured plantar fascia to promote healing. 

High energy ultrasound may also help to alleviate the symptoms of plantar fasciitis. Percutaneous ultrasound-guided needle tenotomy, a treatment in which a needle is inserted into the tissue to create small holes and increase circulation to the area, is also effective for some patients. The needle is driven under ultrasound guidance, just like it is done for a corticosteroid injection into the plantar fascia.

If conservative and minimally invasive treatments do not relieve a patient’s pain, surgery may be necessary. Dr. Braaton is a highly experienced orthopedic surgeon who will work with you to determine the best treatment option for your condition.

Open surgery for plantar fasciitis may involve a partial incision in the plantar fascia to relieve tension. Typically, the tissue is resected in the middle of the plantar fascia, leaving the outer bands of tissue intact to prevent the development of a flat foot. The abductor muscle may also be released to prevent Baxter’s nerve entrapment, which can cause pain. If heel spurs are present, they are typically removed during the procedure to prevent potential irritation.

If you have chronic heel pain and would like an evaluation for plantar fasciitis or if you are interested in plantar fasciitis treatment, call OrthoMed Center at (209) 524-4438 to schedule an appointment. For your convenience, you may also request an appointment online.