​Plantar
Fasciitis

Common Foot Problems

Plantar Fasciitis

Plantar Fasciitis, a condition sometimes also called heel spur syndrome, is the most common cause of heel pain. These condition names are used together when a spur is present. Other factors, such as a stress fracture, nerve irritation, tendonitis and arthritis may contribute to heel pain. Rarely, a cyst may also cause heel pain.

Since the potential causes vary widely, evaluation by Dr. Radovic is imperative to properly identify the source of heel pain. A foot and ankle specialist, Dr. Radovic will rule out the various possibilities to diagnose the cause of your heel pain.

Plantar fasciitis is an inflammation of the plantar fascia, the band of tissue that spans from the heel to the toes. Heel pain results from the fascia becoming irritated and then inflamed.

Plantar fasciitis is most often cause from an abnormal foot structure. For example, people with overly flat feet or high-arched feet are more likely to develop plantar fasciitis.

Wearing flip flops and other improper footwear on hard, flat surfaces puts stress and strain on the ligament and can contribute to inflammation. Risk factors include obesity, and jobs requiring long hours of standing and walking.

Plantar fasciitis is associated with the following symptoms:

  • Pain on the bottom of the heel
  • Pain in the arch of the foot
  • Pain that worsens upon standing
  • Pain that becomes more severe within months

The pain from plantar fasciitis is worse when arising in the morning or after prolonged periods of inactivity. A few minutes of walking lessens the pain because the fascia ligament stretches when walking. Sometimes the pain goes away but returns after standing or walking after extended periods of activity.

Dr. Radovic will obtain your medical history and examine your foot to reach a diagnosis. He will rule out all the possible causes for your heel pain before diagnosing plantar fasciitis.

X-rays or other imaging modalities can aid in identifying the different types of heel pain. Heel spurs are sometimes associated with this condition, but are rarely the cause of pain. When heel spurs are present with plantar fasciitis, the condition may be diagnosed as plantar fasciits/ heel spur syndrome.

Non-surgical treatment of plantar fasciitis can begin with home care strategies:


Stretching exercises. Stretching the calf and plantar fascia helps relieve pain and accelerate recovery.
Always wear shoes. Walking barefoot puts unnecessary stress on the fascia ligament.
Ice. Reduce inflammation by applying an ice pack to the affected heel for 20 minutes several times a day. Putting ice directly on the skin can be dangerous. Place a towel between the ice pack and your skin to avoid burns or other damage.
Limit activities. Moderate your physical activities to rest the plantar fascia.
Shoe modifications. Proper shoes with arch support and a slightly raised heel reduce pressure on the heel.
Medications. To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) including Advil and Motrin.

Patients who have persisting pain after several weeks should consult Dr. Radovic, who may combine one or more of these treatment methods:

Orthotic devices. Personally customized orthotics fitted into dress shoes, or athletic shoes, help correct the structural abnormalities contributing to plantar fasciitis.
Injection therapy. Local injection of corticosteroids may help relieve pain and inflammation.
Removable walking cast. This device may be used for 2-3 weeks to immobilize the foot and allow it to rest and heal.

Night splint. A night splint allows the plantar fascia ligament to stretch overnight, and may minimize the morning pain that is often experienced.
Physical therapy. Massage, stretching and exercises may be used, among other physical therapy measures, to provide benefit.

Surgery is considered when in a small percentage of patients who are unresponsive to non-surgical treatment. If heel pain persists after several months of non-surgical treatment, Dr. Radovic will discuss surgical options and determine the most beneficial approach for each individual case.

Regardless of the treatment plan followed for plantar fasciitis, the underlying causes of this condition may not resolve. Patients need to continue wearing supportive shoes, using custom orthotic inserts and stretching for long-term relief from plantar fasciitis.

Summary of Benefits

Summary of benefits of current treatment options for Plantar Fasciopathy:

PHASE 1 :

Stretching of calf and arch

High Level Evidence
Over-the counter arch supports 
Medium Level Evidence

Cryotherapy

Medium Level Evidence
Night splints
Medium Level

NSAIDS

Low Level (unless inflammatory arthropathy)
Physical Therapy (UltrasoundS & Iontophoresis)  
Low Level
PHASE 2 :
High Level Evidence
Medium Level Evidence
Cortico-steroid injection
Medium Level Evidence
Platelet Rich Plasma(PRP/ABI)
Low Level
SURGERY
Endoscopic Plantar Fasciotomy 
High and Medium Level Evidence
Open and Percutaneous Fasciotomy
Low Level
Gastrocnemius recession  
Low Level

TOPAZ 

Low Level
Experimental/Under-reported therapies
LASER, Acupuncture, Needling, massage

Adapted from: Saxena, A, Fullem, B “Plantar Fascial Injuries” in Foot and Ankle in Sports Medicine ( editors: David W. Altchek, M.D., Jonathan T. Deland, M.D., Christopher DiGiovanni, M.D.,Rock G. Positano, DPM, MSC, MPH, and Joshua Dines, M.D.) Lippincott 2012

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