The plantar fascia runs the length of the sole of the foot and functions to assist in maintaining its inner arch; like the string of a bow, with the bones of the foot being the bow itself. There are many other structures in the foot that also assist in this function. Accordingly, if it ruptures or is released in operation, the arch does not collapse.
Plantar fasciitis is an inflammation of the origin of the fascia at the calcaneus (heel bone). It is a result of a repetitive strain/tear and repair of the fascia from traction forces that have worn it out. It can be likened to an elastic band that has been left out in the sun and stretched too many times; it loses its stretch and has many micro-tears in it.
Heel spurs have long been associated with heel pain, and were originally thought to be its cause. Heel spurs occur at the origin of the flexor digitorum brevis muscle, which lies just deep to the plantar fascia. However, heel spurs are usually the result, and not the cause of heel pain associated with plantar fasciitis. They form because of the local inflammation in the soft tissue, with the body forming bone mistakenly in its attempt to repair the plantar fascia.
Treatment – Non-operative
Initial management of plantar fasciitis involves a multi-modal non-operative approach. For 90% of people, this is all that is required. This includes rest, stretching and strengthening exercises, orthoses including heel pads and night splints, anti-inflammatories and corticosteroid injections.
Rest can help ease the swelling and pain experienced in the foot. Avoid walking long distances, running, physical activity, standing for prolonged and bearing weight on the affected foot. Use crutches if necessary.
Physiotherapy along with strength and conditioning exercises, are useful to regain range of movement, strength, balance and joint position sense.
Heel Pads and Night Splints
Heel pads and night splints can offer support by decreasing over-pronation that may exacerbate symptoms.
Painkillers and anti-inflammatory medication such as tablets and creams can be prescribed by your doctor to assist in reducing pain.
A targeted corticosteroid injection may offer relief from foot inflammation and help settle symptoms, so that physiotherapy can continue.
Treatment – Surgery
For those patients who have ongoing pain despite adequate non-operative management, operative intervention is required. In the past, this procedure has been performed with a large incision on the in-step of the foot. This was associated with a high rate of complications. Endoscopy, or keyhole surgery minimises these risks; following research in 2009 involving 110 patients, I along with another orthopaedic foot and ankle surgeon in Melbourne have demonstrated the procedure to be superior to the conventional technique. This includes improved patient satisfaction, less post-operative pain, quicker recovery times, and a lower complication rate. X-rays of feet whilst weight bearing 2.5 years following surgery, also demonstrated that no arch collapse occurred what so ever.
The 15-minute procedure involves making 2x 5mm incisions – 1 on each side of the foot. This enables a telescopic camera and instrumentation to be inserted to complete the release of the plantar fascia. Patients are then allowed to weight bear as tolerated, and quite often have less pain than prior to the procedure within 1-2 weeks. By 3-4 weeks, patients are walking well, and have returned to sport by six weeks. These are the average guidelines for recovery. I have undertaken this procedure on several AFL and other National level athletes and they have returned to full sporting activities within 3-4 weeks.
RISKS AND COMPLICATIONS
Complications are rare with this procedure, occurring in less than 5% of people. Aside from the usual risks of surgery, such as infection & blood clots, a temporary hypersensitivity of the foot may occur and delay recovery. There is a higher incidence of this problem occurring when the patient has pre-existing back pain or nerve symptoms in the leg, foot or ankle region. An active rehabilitation program with an experienced physiotherapist or podiatrist is important in minimising this risk.
Finally, and uncommonly, pain in the outer part of the top of the foot may occur following any technique of plantar fascia release. This is thought to be due to unmasking pre-existing arthritis of the foot. Very seldom is this enough of a problem to require further surgery and usually only orthotic inserts for the shoes are required.
|Hospital stay||Day surgery|
|Rest and elevation||1 week|
|Time off work |
|Foot swelling||3-4 weeks|
This fact sheet is a brief overview of plantar fasciitis produced by our Foot and Ankle Surgeon Dr James Clayton. To make an appointment or enquiry with Dr Clayton, contact 08 8362 7788 or email firstname.lastname@example.org.