By Rehan Iqbal
Most people who have plantar fasciitis (aka: “first-step-pain”) experience heel pain when arising from bed each day or after they have been sitting for quite a while. What can you do about plantar fasciitis? Do you need surgery? In this article, we explore these questions and the choices.
If you are experiencing heel pain, you may have plantar fasciitis (PLAN-tar fash-ee-EYE-tus) which happens when the plantar fascia (the flat, long ligament on the sole of your foot) becomes torn and strained. When this happens, the ligament can become irritated, swollen and weak causing pain at the connection point of the ligament at the calcaneous (heel bone).
Surgery is usually a last resort and consists of releasing a portion of the plantar fascia with incisions aimed at relieving the tension in the ligament, thereby reducing the swelling and inflammation. This surgery may be conducted using an endoscope, which is inserted into the affected area through very small incisions. It may also be performed as open surgery, meaning that the surgeon would make a larger, open incision into the affected area.
Endoscopic Plantar Fascia Release
Another type of plantar fasciitis surgery is called gastrocnemius release or recession. It is intended to lengthen the gastroc tendon, which is connected to the Achilles tendon. If you have very tight calf muscles (equinus contracture) your doctor may recommend this procedure.
Endoscopic Gastrocnemius Recession
What’s the Difference Between Endoscopic and Open Surgery?
If you have open surgery, you will need to wear a brace for a minimum of two weeks. This could be extended to three or four weeks depending upon your rate of recovery.
If you have endoscopic surgery, you will be able to bear weight on your foot right away. When you are able to comfortably wear your regular shoes, you may do so, as long as they are good quality, supportive shoes in good condition.
With either type of surgery, you should be able to resume your usual activities of daily living (ADL) within 3-6 weeks, but you should not participate in stressful sports for a minimum of 3 months. You must avoid the impact caused by running and jumping.
How Do You Know If You Need Plantar Fasciitis Surgery?
Most of the time, surgery is not needed, but when it is about 75% patients who have it report resolution of pain. About 25% continue to experience pain.
If you’ve consistently tried conservative care for plantar fasciitis for 6-12 months, but you continue to experience severe heel pain, you may be a good candidate for surgery. If your heel pain is interfering with your ability to perform ADL and/or to work, surgery may be considered sooner rather than later.
Is Plantar Fasciitis Surgery Risky?
All surgery comes with risks. Some common complications of plantar fasciitis surgery include:
How Is Plantar Fasciitis Treated?
There are a number of non-surgical ways to deal with plantar fasciitis. These work best if you identify the problem and begin treatment as soon as you notice your symptoms. Conservative treatment of plantar fasciitis includes:
- 1RICE protocol: Rest, Ice, Compression and Elevation are always helpful for irritated, damaged, swollen, weak ligaments.
- 2NSAIDS: Non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen and naproxen sodium can help relieve pain and inflammation.
- 3Exercise: Staying in good physical condition generally can help you avoid developing plantar fasciitis. Stretching and strengthening exercises for the feet and ankles can provide focused relief and recovery.
- 4Modified exercise program: You may wish to reduce the amount you walk or run or even change entirely to cycling and/or swimming.
- 5Support: Shoe inserts, arch supports and heel cups can be extremely helpful in providing relief from pain. You may need prescription orthotics from your doctor, but more often than not, over the counter (OTC) products can bring a great deal of support and relief.
- 6Taping: You may wish to tape your foot or ankle for extra support.
- 7Night splints: There are a number of options in supports and splints to be worn while you sleep to help stretch your calves, correct your foot problems and relieve pain.
- 8Shock wave therapy creates microscopic trauma to already damaged tissues and stimulates a natural healing response.
- 9Steroid injections may help relieve pain and inflammation.
The most important thing to remember when applying conservative care to plantar fasciitis is that it’s not a one-off. You must set yourself a schedule of RICE, NSAIDS and exercise and stick with it. If your doctor instructs you to use orthotics and/or night splints, you must do so in a consistent manner. With conservative care for plantar fasciitis, you will not be able to recover and go your merry way. You’ll need to instill care and strengthening habits into your daily life on a permanent, ongoing basis.
What Will Happen If You Don’t Treat Plantar Fasciitis?
Without some sort of treatment, the pain of plantar fasciitis will only worsen. This chronic pain may affect your gait and the way you stand. With the passage of time, your pain may spread up your legs and into your hips causing pelvic and back problems. If you are suffering from chronic plantar fasciitis, you will surely eventually find that it interferes with your ability to work and play and generally perform ADL.
Does Heel Pain Always Mean Plantar Fasciitis?
Heel pain can be caused by a number of different conditions, including:
Sometimes, small insignificant heel spurs will develop because of plantar fasciitis. These do not typically cause pain and are usually left in place when plantar fasciitis surgery is performed. If a heel spur is very large, it can cause pain and may be removed.
How Can You Prevent Developing Plantar Fasciitis?
Sometimes plantar fasciitis is caused by the construction of your feet and may develop slowly over time. If you have high arches or flat feet or constricted Achilles tendons, your gait may be negatively impacted. You may tend to roll or twist your foot inward or outward as you walk or run. All of these factors may conspire together to cause the development of plantar fasciitis.
Other factors, such as being in poor general physical condition and/or being overweight can cause stress on your feet, ankles and legs, leading to plantar fasciitis. A sudden change or increase in activity may also cause irritation of the plantar fascia.
Plantar fasciitis may also be caused by stepping wrong or jumping down from a considerable height.
To avoid the tears, stress and inflammation that result in chronic pain, it is always wise to stay in good physical condition and introduce new physical activities gradually. Exercise and stretch regularly. Focus stretching on the plantar fascia and the Achilles tendon.
Get ample rest, eat well and be sure to wear good quality, supportive footwear. Look for shoes that offer good ankle support. Your shoes and boots should always be kept in good condition, and you should always wear the right shoes for the purpose you have in mind.