You might have heard that plantar fasciitis is also known as heel spur syndrome. A name like that might make you think that your moderate to debilitating pain is caused by growths of bone on the bottom of your heel bone and that there’s nothing you can do about it, short of surgically removing the spurs. Plantar fasciitis is unrelated to the heel spurs. Heel spurs are typically not a source of pain. That means there’s something you can do about it without having surgery. The pain is caused by inflammation of the plantar fascia, the ligamentous band that connects the heel to the toes. It helps keep the structure of your foot together, along with your other soft tissues. When the plantar fascia is overused or too tight, you might experience severe pain in the bottom of your heel or along the bottom of your foot.
It Might Not Be Plantar Fasciitis
Before undergoing treatment, it’s vital to get a proper diagnosis from a foot and ankle specialist. Several other conditions cause pain to the heel and bottom of your foot, mimicking plantar fasciitis. When you talk to your specialist about your pain, he or she will ask when you feel it. If you feel the pain when you first stand up after resting, that could indicate plantar fasciitis. If you feel the pain after prolonged standing or a long walk or run, your doctor might want to check for a stress fracture of the heel bone or tarsal tunnel syndrome instead. A physical exam will reveal whether you experience discomfort when pressure is applied to the fascia and whether you experience pain when the heel is squeezed. Discomfort during pressure on the fascia without discomfort during squeezing of the heel indicates plantar fasciitis. Xrays are helpful to rule out other causes, and an ultrasound or MRI may be needed to confirm a diagnosis before any advanced treatments.
Only 10% of patients need surgery to stop their pain. Multiple surgical approaches exist to help alleviate the tension and eliminate the inflammation of the plantar fascia. A plantar fasciotomy will release the part of the ligamentous band through a small incision. This surgical procedure will immediately stop the tension and the pain. Another approach involves a more minimal technique through a series of poking small holes in the heel to relieve the pain, combined with a release of fascia in the calf muscle. These are performed as outpatient procedures with little to no downtime. You can return to activities and work shortly after with confirmation from your doctor.
Stretching is the key to treatment, focused on your calf and hamstring muscles with a lesser focus on the ligament. Stretching can improve function and gain range of motion alleviating tension to the plantar fascia, which is sometimes enough to stop the inflammation that’s causing your pain. You can stretch at home or work and without even needing to stand up. This treatment is usually coupled with others as some patients find it difficult to stretch with the pain. Physical therapy is an excellent adjunct that helps patients improve faster!
Shoes and Orthotics
Shoes can make a significant impact quickly. Shoes should provide arch support and a little bit of heel height to offload the plantar fascia better. Over-the-counter inserts or custom orthotics can provide additional support to shoes or make existing shoes better. You can find rigid over-the-counter inserts at your local running/sports store or drugstore. Depending on your foot structure or shoe type, your doctor might recommend a custom orthotic. Custom orthotics can be made for dress shoes or cleats. Night splints are a device worn in the evening hours or while sleeping to help maintain the Achilles tendon’s length to reduce morning pain.
Injection therapies come in many different forms. Cortisone injections are the most common. They are put directly into the plantar fascia’s painful area to reduce inflammation and, therefore, pain. It also helps to break down thickened tissue from inflammation. You are limited on the number of cortisone injections due to the adverse effects it can have with frequent use. With medical advances, patients receive stem cells, Platelet-Rich Plasma (PRP), and amniotic fluid injections with excellent results. These substances are potent anti-inflammatories that stimulate healing with fewer adverse effects compared to cortisone.
Anti-inflammatories can help with the pain while you go through your other treatments. They can be applied topically (on the skin), orally (ingested), or injected into the foot, as mentioned above. Anti-inflammatories can be over-the-counter or prescription, depending on your doctor’s recommendation and your pain intensity.
Dr. Brett J. Waverly is a podiatrist/foot and ankle surgeon providing comprehensive foot and ankle care with an extensive background in non-surgical and surgical treatment.
To schedule an appointment, please call 541-754-1276.