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Plantar Fasciitis

The Condition

Plantar fasciitis is an inflammatory condition of the supportive soft tissue found at the bottom of the foot. This fibrous tissue connects the heel bone to the forefoot. The plantar fascia functions in arch support and stability. Overuse injuries are commonly responsible for this structure becoming inflamed and painful. Conditions such as ‘flat feet‘ or pes cavus (increased arch height) can also contribute.

Common symptoms of plantar fasciitis:

  • Pain to the bottom of the heel or arch
  • Increased pain with initial steps in the morning after arising from bed or after periods of rest
  • Gradual increase in pain over several weeks or months
  • Aching pains of the heel at the end of the day

The Treatment

Surgical and conservative care options are available to treat this condition. Surgery is typically reserved for a small percent of the population that fail to improve with conservative care. Stretching exercises, ice application to the heel and arch, activity modification, physical therapy, custom foot orthotics, and the use of more appropriate shoes can help in reducing symptoms of pain. Oral anti-inflammatory medication, injectable steroids and platelet rich plasma (PRP) prolotherapy injections can help reduce tissue inflammation associated with this condition.

Plain film radiographs (X-rays) are typically ordered at the initial consultation. This test helps your podiatrist rule out the possibility of other conditions mimicking plantar fasciitis. In some cases a magnetic resonance imaging study (MRI) is ordered to evaluate the plantar fascia for possible tearing.

Frequently Asked Questions

Injection therapy is a mainstay of conservative treatment for plantar fasciitis. Injections given under ultrasound guidance eliminate the guesswork of needle placement and provide better results. However, each patient is different and the amount of relief experienced from the injections can vary. Some people may require only one injection while others may benefit from several throughout the course of treatment.

Prolotherapy, also referred to as regenerative injection therapy, is a non-operative method of treatment that can be used to heal injured tendons, ligaments and joints. Platelet rich plasma is one form of prolotherapy that allows physicians to harvest the natural healing ability of the human body to repair the injured tissues. Platelet cells contain growth factors that promote and direct tissue healing. These cells are obtained from the patient via a simple blood draw and are concentrated using a centrifuge. The platelets and their growth factors are then injected into the injured tissue to promote healing. This method of treatment is commonly used to improve painful conditions of the plantar fascia.

No. It is important to wear appropriate shoes and custom foot orthotics to relieve the strain across this soft tissue.

Yes. It is important to allow your podiatrist to perform a thorough history and physical examination to determine the exact cause of your problem. If inflammation of the plantar fascia developed as a result of separate foot pathology, comprehensive treatment will help reduce the chance of symptom recurrence.

Only a small percentage of patients who develop plantar fasciitis actually require surgery. This determination will be made on a case-by-case basis and is dependent on what conservative care has been tried and how long conservative measures have been attempted. If surgery is indicated, the recovery is quick and immediate weight bearing is allowed.

No. There are a number of problems that can cause heel pain including tarsal tunnel syndrome, foot fractures, Achilles tendon problems, arthritis, and peroneal tendon injuries. If you are suffering from heel pain you should have your podiatrist perform a detailed examination to accurately diagnose and treat your problem.

Articles

A Patient’s Guide to Natural Healing: Autologous Conditioned Plasma (ACP)This brochure further explains the platelet rich plasma prolotherapy treatment currently offered at JCMG Podiatry.

Shot Can Help Heel PainIn this article KRCG’s Teresa Snow interviews the JCMG podiatrists regarding ultrasound guided injections for the treatment of plantar fasciitis.