Plantar Fasciitis

Plantar fasciitis is commonly referred to as “heel spur syndrome”. It is inflammation of the plantar fascial band that runs from the bottom of the heel to the ball of the foot. This band acts as the “bowstring” of the foot – helping to maintain the arch.

Many other disorders can cause heel and arch pain – -but plantar fasciitis is the most common heel problem that we treat. A variety of foot injuries, foot structure or improper foot mechanics can lead to plantar fasciitis.

Common Causes
  • Weight gain
  • Excessive weight bearing activities such as running, jumping, climbing ladders, and any impact sports activity
  • Wearing high heels for many years leads to equinus (short muscles in the back of the calf)
  • Excessive pronation due to instability of the ligaments of the feet.
  • Wearing improper shoes with little to no support such as earth shoes or shoes with a negative heel height.

Symptoms
Exquisite pain first thing in the morning or upon getting up after having been non weight-bearing for a period of time.
A burning or deep bruised sensation in the arch or bottom of the heel – that can sometimes extend to the bottom side (plantar aspect) of the toe joints.

Common Treatments

Home Remedies

  • Icing & stretching exercises. Leaning forward on a wall with your feet in a high arched position will help to stretch the calf muscle.
  • Weight loss and reduction in high impact activities
  • Good, supportive shoes that offer a slight heel – perfectly flat or negative heel shoes/sandals can exacerbate the symptoms
  • Over the counter inserts might provide relief if symptoms are acute, but are rarely of much long term benefit for chronic plantar fasciitis.
  • NSAIDs to reduce inflammation and pain

When Home Remedies don’t help, it’s time to schedule an appointment to see a podiatrist. For our heel pain patients, we perform a complete foot exam and obtain x-rays so we can see the bony structure. Often, we see a large exostosis (bone spur) on the bottom of the heel (and sometimes on the back of the heel as well). It is not the bone spur itself that is causing the pain, but the tearing of the plantar fascia away from the bone. The periosteal membrane responds by laying down bone – – hence the formation of the spur.

Podiatric treatments may include:

Physical Examination to help the physician pinpoint the area of pain and determine the cause.

X-rays to view the bony structure of the foot.

Diagnostic Ultrasound that allows us to see the soft tissue structures such as the plantar fascia and fluid sacs known as bursas.

Low-Dye Strappings which transfer tension to the shin disallowing elongation of the arch which reduces tension on the plantar fascia. The strapping is worn for up to a week, and if it resolves or greatly reduces the pain, it tells us that a prescription foot orthotic will likely be the treatment of choice, to provide a more permanent alignment of the foot’s structure.

Steroid Injections might also be indicated if your pain level is severe. The injection is usually followed by a Low-Dye strapping to provide support and prevent re-injury at the origin of the fascia.

Prescription NSAIDs might be prescribed to help reduce the inflammation

A series of stretching exercises may be prescribed to help stretch the muscles in the back of the leg.

Surgical Intervention

Partial Plantar Fasciotomy – Topaz Procedure (small holes are surgically induced into the plantar fascial band (fenestration) to allow it to lengthen slightly and reduce some of the strain).

PRP Injection (Plasma Rich Protein) Performed in conjunction with a Topaz fenestration procedure. PRP is derived from the patient’s own blood and contains growth factors that promote healing and strengthening of the fascia.

Plantar Fasciotomy (release of the plantar fascia). This should be the last resort – not one of the first options considered. When you release the plantar fascia, it allows your foot to flatten out which can cause forefoot problems such as hammertoes and bunions.

Call Central Carolina Foot and Ankle Associates at 919-477-9333 for an appointment or click the link below.

Central Carolina Foot & Ankle Associates

NORTH DURHAM
CENTRAL MEDICAL PARK
2609 N. Duke Street, Ste. 301
Durham, NC 27704
(near the corner of N. Duke St. and Stadium Dr.)
919-477-9333

SOUTHWEST DURHAM
HIGHGATE CENTRE
5107 Southpark Drive
Suite 202
Durham, NC 27713
(close to RTP and Chapel Hill)
919-544-2583