Heel pain associated with plantar fasciitis can be debilitating. As an acute pain, plantar fasciitis usually comes and goes due to inflammation. It can easily become chronic causing the pain to be persistent and daily (plantar fasciosis). There are many ways to treat this type of heel pain, especially with the newer treatments recently introduced. The appropriate method of treatment is to first differentiate between an acute versus chronic condition.

What is plantar fasciitis?

Plantar fasciitis is an acute inflammation of the plantar fascia. The plantar fascia is a thin band on the bottom of the foot from the base of the toes to the heel. It is almost the width of the foot.

What are the symptoms of plantar fasciitis?

It usually presents with pain in the heel and arch area of the foot. Pain is usually more noticeable with the first few steps in the morning, after sitting for long periods, or even after a long car drive. The pain lessens after the initial “jolt” with the first few steps but is present throughout the day. For some people the pain occurs after excessive activities or sports. Plantar fasciitis is usually a precursor to plantar fasciosis.

What are the symptoms of plantar fasciosis?

Chronic plantar fasciitis presents as ongoing pain throughout the day which is minimally affected with acute plantar fasciitis treatment (see below).

What causes plantar fasciitis?
The usual precursor to the plantar fasciitis is poor biomechanics of the foot. After relieving the pain, the foot type has to be addressed to avoid reoccurrence. Lack of stability/support will lead to plantar fasciitis and other foot ailments.

Acute plantar fasciitis treatment:

• Rest
• Ice
• Anti-inflammatories
• Stretching of plantar fascia prior to weightbearing
• Stable/supportive shoes (preferably athletic shoes) until pain resolved
• Steroid injections
• ORTHOTICS (please see information on orthotics at www.feetfixer.com )

Chronic plantar fasciosis treatment (after failure of acute treatment options):

Nonsurgical treatment options:

• Platelet Rich Plasma (PRP)

The patient’s blood is drawn in-office and spun in a centrifuge machine to obtain platelet rich material. This material contains an abundant amount of growth factors. Using ultrasound guidance, the platelet rich plasma is injected into the plantar fascia at area of scar tissue/pain. This injection changes a chronic condition to an acute condition and the growth factors will then be able to address and heal the inflammation. Patients are placed in a boot or cast for two week during the healing process. This same procedure can be used in other tendon areas such as the Achilles tendon.

• Extra Corporeal Shock Wave Therapy (ESWT) Heel Pain Treatment

ESWT uses soundwaves (similar to Lithotripsy for kidney stones) to eliminate plantar fasciosis pain and helps repair the plantar fascia. ESWT has been known to initiate the formation of new blood vessels. This acts to jump-start a normal inflammatory response allowing plantar fascia repair. The shock waves can also act to over-stimulate pain transmission nerves, leading to a reduction in sensitivity and discomfort.

This non-invasive procedure takes approximately 20 minutes in a surgery center setting. Right after the procedure patients can return to normal daily activities in stable shoes.

Surgical treatment options:

• Endoscopic plantar fasciotomy

The inside painful border of the plantar fascia is cut, using a scope, to relieve the tension of the band. It allows for small incisions and faster healing. This procedure is performed in a surgical center or hospital setting. Patients are placed in a walking boot after surgery for ~ 4 weeks.

All procedures discussed address the plantar fascia and the pain associated. The foot type, which initiated the pain, has to also be evaluated and treated. This can be done with properly made custom orthotics (see Orthotics at www.feetfixer.com )