Plantar fasciitis is a frequently observed deformity which commonly affects individuals who are active in the sport, overweight/obese or have structural anomalies such as high arches or flat feet. Heel pain can be successfully treated with non -surgical care. However, in those circumstances where conservative treatment fails, surgery may be indicated
Causative factors include micro or macro trauma leading to fascia tear and sub-sequential inflammation, genetic predisposition to structural foot anomalies, local and systemic musculoskeletal diseases such as rheumatoid arthritis leading to altered foot structure, ill-fitting footwear and obesity.
Diagnosis is made through clinical assessment although ultrasonography and x-rays may be useful in ascertaining a diagnosis. Clinical assessment involves determining the exact nature of the patient’s symptoms.
- Orthotic therapy may be helpful in offloading the painful heel
- NSAID/steroid therapy to alleviate symptoms associated with inflammation
- Calf stretching exercise would also be useful for tight Achilles tendons
- Extra Corporeal Shock Wave Therapy [ESWT] has been shown to be an effective alternative for those who do not respond to more conservative therapy
The aim of surgical intervention is to eliminate pain and restore function. Techniques used include plantar fasciotomy and tarsal tunnel release. Depending on the cause of the heel pain, surgery may involve the removal of bone spurs, removal of scar tissue or the release of nerve compression. This procedure is performed as Day Surgery. Plantar fasciotomy is a minimally invasive and minimally traumatic surgical treatment for the common problem of chronic plantar fasciitis. This procedure is indicated only for the release of the proximal medial aspect of the fascia in cases that do not respond to aggressive conservative, nonsurgical treatment. In the literature, an overall 87% success rate has been reported in 1228 procedures, in addition to an 83% success rate reported by Burke at the Northwest Podiatric Foundation Surgical Seminar in January 2000. The author’s personal experience with 41 procedures over 5 years is consistent with an overall average success of 90%. (Hake, D. H. (2000). Endoscopic Plantar Fasciotomy: A Minimally Traumatic Procedure for Chronic Plantar Fasciitis. The Ochsner Journal, 2(3), 175–178.)