Plantar fasciitis is a foot condition marked by inflammation in the plantar fascia, a robust band of tissue supporting the arch of the foot. Similar to an overstretched rubber band, the plantar fascia loses its stretch and develops micro-tears, becoming irritated and inflamed and leading to discomfort, particularly in the heel area. This condition can make walking or even standing a challenge and if left untreated, can persist and significantly impact daily activities.
The plantar fasciitis functions to cushion the significant pressures and tensions experienced during standing, walking and running. However, too much pressure and tension can damage and tear the tissue, causing inflammation and resulting in heel pain and stiffness.
For years, heel spurs have been linked to plantar fasciitis and were initially believed to be the primary cause. However, it’s now understood that heel spurs are not the root cause of plantar fasciitis-related pain and surgical removal of heel spurs is deemed unnecessary. These bony protrusions likely develop as a response to localised inflammation within the soft tissue, with the body mistakenly forming bone in its attempt to mend the plantar fascia.
The most common symptoms of plantar fasciitis are:
The plantar fascia is a robust band of tissue which plays a pivotal role in supporting the arch of the foot and absorbing shock during weight-bearing activities. Originating from the heel bone (calcaneus), it extends along the sole of the foot, connecting to the base of the toes.
This fibrous structure acts like a bowstring, maintaining the arch of the foot and providing stability during movement. Adjacent to the plantar fascia lie various ligaments, muscles, and bones that collectively contribute to the foot’s biomechanics. Disruptions in this intricate network, such as tightness or weakness in the calf muscles, abnormalities in foot structure, or repetitive strain, can predispose individuals to plantar fasciitis
The first step in treating plantar fasciitis typically involves a comprehensive non-surgical approach, which proves effective for about 90% of people.
This approach includes a variety of methods such as rest, pain relief medications, anti-inflammatory drugs, massage therapy, ice application, and specific exercises aimed at stretching the fascia and enhancing muscle strength. Additionally, orthotic devices like cushioned heel pads and night splints may provide relief. In some cases, corticosteroid injections or alternative therapies such as ultrasound or shock wave therapy may be recommended as adjunct treatments.
As most patients find relief using non-surgical treatment, the need for surgery is rare. For patients experiencing persistent pain despite non-operative treatments, surgical intervention may be necessary.
Traditionally, this procedure involved a sizeable incision on the instep of the foot. However, advancements have led to the development of an endoscopic technique. Benefits of the endoscopic method include enhanced patient satisfaction, reduced post-operative discomfort, quicker recovery periods, and a lower rate of complications.
The endoscopic procedure involves making two 10mm incisions, one on each side of the foot, through which a telescopic camera and specialised instruments are inserted to release the plantar fascia.
Patients are typically encouraged to bear weight as tolerated soon after the procedure, often experiencing decreased pain within 1-2 weeks. By 4 weeks post-surgery, most patients are walking comfortably, with some able to resume sports activities between 6-12 weeks.
Complications with this procedure are rare, occurring in less than 5% of cases, and may include infection, nerve injury, blood clots, or anaesthesia-related issues. Although some patients may continue to experience preoperative pain despite surgery, overall success rates are high, with approximately 90% of patients achieving a favourable outcome.
These notes from OrthoSport Victoria are for educational purposes only and are not to be used as medical advice. Please seek the advice of your specific surgeon or other health care provider with any questions regarding medical conditions and treatment. Image by Freepik
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