Plantar Fasciitis Example

Plantar Fasciitis


Plantar fasciitis is a painful inflammatory condition of the foot. It has been reported plantar fascitis occurs in two million Americans a year and 10% of the population over a lifetime.[1] It is commonly associated with long periods of work-related weight bearing. Among non-athletic populations, it is associated with a high body mass index. The pain is usually felt on the underside of the heel, often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending his foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle).

Plantar Fasciitis Treatment - Non-surgical


While evidence is lacking to strongly support any type of treatment for plantar fasciitis, many non-surgical treatments are available. Stretching of the calf and plantar fascia can provide up to 24 months of benefit. In cases of chronic plantar fasciitis of at least 10 months' duration, one study has shown high success rates with a stretch of the plantar fascia. Most often plantar fasciitis improves within one year of beginning non-surgical treatment, without any long-term problems.

Pain with the first steps of the day can be markedly reduced by stretching the plantar fascia and Achilles tendon before getting out of bed. Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease pain on waking. These have many different designs. The type of splint has not been shown to affect outcomes. Arch supports and taping can provide short-term pain relief. There has not been shown to be any difference between custom-made orthotics and off-the-shelf orthotics.

To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of limited benefit. Dexamethasone 0.4% or acetic acid 5% delivered by ionophoresis combined with low dye strapping and calf stretching has been shown to provide short term pain relief and increased function.

Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, especially if not combined with a local anesthetic and injected slowly with a small-diameter needle. Recurrence rates may be lower if injection is performed under ultrasound guidance. Repeated steroid injections may result in rupture of the plantar fascia. While this may actually improve pain initially, it has deleterious long-term consequences.

Plantar Fasciitis Treatment - Surgical


Surgery carries the risk of nerve injury, infection, rupture of the plantar fascia, and failure of the pain to improve. Surgical procedures, such as plantar fascia release, are a last resort, and often lead to further complications such as a lowering of the arch and pain in the supero-lateral side of the foot due to compression of the cuboid bone. An ultrasound guided needle fasciotomy can be used as a minimally invasive surgical intervention for plantar fasciitis. A needle is inserted into the plantar fascia and moved back and forwards to disrupt the fibrous tissue.

Coblation surgery (aka Topaz procedure) has been used successfully in the treatment of recalcitrant plantar fasciitis. This procedure utilizes radiofrequency ablation and is a minimally invasive procedure.