Heel Pain or Plantar Fasciitis is one of the most common problems that we see patients for in the office. It affects people of almost all ages, except for young children. When young children get heel pain, it is most likely from calcaneal apophysitis or Sever's disease, and ithat is sometimes misdiagnosed as planter fasciitis. This problem occurs with growth plate irritation on the back and bottom of the heel.
Plantar fasciitis occurs when the plantar fascia gets inflamed and gets small tears within its origin on the calcaneus. It causes pain that can be all day long and worsening throughout the day, but more commonly is seen when patients first get out of bed in the morning.
A tight Achilles tendon, also called equinus, is one of the leading causes of plantar fasciitis. Some home therapy that we recommend for plantar fasciitis is icing the heel 20 minutes twice a day, and aggressive Achilles tendon stretching exercises to try to loosen the calf muscle.
Other common home treatments that we recommend are avoiding barefoot especially in the house and trying to wear a stiff and supportive shoe. Over-the-counter arch supports can be helpful to treat plantar fasciitis, but it is important not to try to get a heel cushion. We think cushioning does not really help plantar fasciitis very much, but a stiffer and more supportive over-the-counter orthotic can be helpful to take tension off the plantar fascia. If the orthotics supports the fascia appropriately, we think this helps stop the tearing and allow the plantar fascia to heal.
If these home treatments have not worked, we can try different treatments in the office like cortisone injections, using a night splint to help stretch the foot, and custom made orthotics. There are other types of stem cell injections that we sometimes utilize for this problem as well that can be helpful.
If patients have tried conservative care for at least 6 months and the heel pain has not gone away, surgical options are also available. Most of the time with chronic plantar fasciitis, we need to address the equinus deformity and we typically perform a gastrocnemius recession to facilitate this. The other surgical treatment for the plantar fasciitis involves releasing a portion of the plantar fascia either via an open or endoscopic approach.
Most people with chronic plantar fasciitis also developed a heel spur or calcaneal spur. We think the spur does not actually cause any pain, but sometimes patients will choose to have the spur removed at the same time they have an open plantar fasciotomy performed.
Typical postop recovery for surgeries like this involve 3 weeks of being nonweightbearing and then several more weeks of being partially weightbearing in a protective Cam walker boot. Typically around 6-7 weeks after surgery, patients can return to regular shoes and then start physical therapy to work on strengthening..
If you are suffering from any foot and ankle pain or problems, call your expert Colorado Springs podiatrists today at 719-488-4664 so we can help you!
