Not all heel pains are caused by plantar fasciitis. It refers to a very specific, localised pain under the heel, in the absence of other pathology. The pain seems to be caused by recurrent micro tearing of the fascia. A bone spur can result, but is rarely important in the pain.
The majority of cases will improve without surgery. Non-operative treatments can include soft heel inserts, an orthotic with a cut-out under the painful area, and anti-inflammatory tablets. Stretching and strengthening exercises may help (1). Injections have reasonable results – up to three injections of cortisone are possible. Some sports medicine doctors are now using blood or PRP injections (2). Radial shockwave treatment (SWT) is another non-invasive treatment that can be helpful (3).
If these measures fail to settle the pain, surgical treatment is occasionally undertaken. Endoscopic release of 80% of the plantar fascia produces the most successful outcomes in thin, athletic, non-diabetic patients with only one foot involved. (4, 5, 6)
References:
1. Digiovanni BF, Nawoczenski DA, Malay DP et al. Plantar Fascia-Specific Stretching Exercise Improves Outcomes in Patients with Chronic Plantar Fasciitis. J Bone Joint Surg Am 2006; 88(8):1775-1781
2. Lee TG, Ahmad TS. Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis. A prospective, randomized, controlled trial. <ajour’,%2520’foot%2520ankle%2520int.’)%3b” href=”file:///javascript/AL_get%28this,%2520%27jour%27,%2520%27Foot%2520Ankle%2520Int.%27%29%3B”>Foot Ankle Int. 2007;28(9):984-90
3. Ibrahim Ibrahim M et al. Successful treatment of chronic plantar fasciitis with two sessions of radial extracorporeal shock wave therapy. Foot Ankle Int 2010;(31):391-397
4. Othman AM; Ragab EM. Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis. Arch Orthop Trauma Surg 2010 Nov;130(11):1343-7.
5. Radwan YA; Mansour AM; Badawy WS. Resistant plantar fasciopathy: shock wave versus endoscopic plantar fascial release. Int Orthop 2012 Oct;36(10):2147-56
6. Saxena A, Uniportal endoscopic plantar fasciotomy: a prospective study on athletic patients. Foot Ankle Int 2004 Dec;25(12):882-9.
~ Mr David Mitchell & Dr Greg Harris