What is Plantar Fasciitis and How is it Treated?
One of the most common conditions we see here in our NYC podiatry office is plantar fasciitis.

Do I Have Plantar Fasciitis?

Plantar Fasciitis is a common foot condition characterized by pain and inflammation in the plantar fascia. The plantar fascia is a thick band of tissue that runs along the bottom of the foot, connecting the heel bone to the toes. The hallmark symptom is a sharp or stabbing pain in the bottom of the heel, especially during the first steps in the morning or after periods of rest.

Pain can also arise after prolonged standing or walking which is why this condition is especially common in pedestrian dominant cities like NYC. Diagnosis is made through physical examination, clinical history, and imaging studies such as x-ray, ultrasound, or MRI to rule out other potential causes of heel pain.

Plantar fasciitis treatments

Treatment often involves conservative measures such as stretching exercises, orthotic devices, supportive footwear, physical therapy, and anti-inflammatory medications. In severe or persistent cases, more advanced treatments like injections or surgery may be considered.

There are many considerations that go into creating a treatment plan, so come see us at AIRE Podiatry to establish your treatment plan.

Non Surgical Treatments:

Stretching
Physical Therapy
Taping or Strapping
Orthotics
Shockwave
Night Splint
Steroid Injections

Surgical Treatments:

Tenex
Plantar Fascia Release
Gastrocnemius Recession
Radiofrequency Microtenotomy
Endoscopic Plantar Fasciotomy

Non Surgical Plantar Fasciitis Treatments

Stretching:
Stretching plays a vital role in managing plantar fasciitis by helping to alleviate symptoms and improve flexibility in the plantar fascia and surrounding structures.
Stretching is beneficial for plantar fasciitis because it relieves tension on the plantar fascia, calf muscles, and Achilles tendon.

Tightness in these areas can contribute to increased strain on the plantar fascia, leading to pain and inflammation. Stretching helps reduce tension in these structures, thereby alleviating stress on the plantar fascia.

Stretching also improves flexibility and range of motion in the foot, ankle, and calf muscles which can decrease the likelihood of micro-tears or injury in the plantar fascia during movement. The most common complaint with plantar fasciitis is pain with the first steps of the day.

Gentle stretching exercises, especially when performed consistently, can ease this discomfort and stiffness while promoting blood flow to the affected area. Increased blood flow aids in the healing process by supplying essential nutrients and oxygen to the tissues, assisting in repair and reducing inflammation.

Physical Therapy:
Conservative physical therapy for plantar fasciitis involves a range of non-invasive treatments aimed at reducing pain, inflammation, and improving the strength and flexibility of the foot.

These therapies are typically the first line of treatment before considering more invasive options. Conservative physical therapy for plantar fasciitis utilizes techniques such as ultrasound massage, lymphatic drainage, neurostimulation or mobilization may help reduce tightness in the foot, calf, and lower leg muscles, promoting better mobility and reducing pain.

Taping or Strapping:

Using specific taping or strapping techniques can provide temporary support to the foot’s arch and relieve tension on the plantar fascia. If strapping is helping the patient, orthotic devices are often employed as an adjunctive therapy.

Custom or prefabricated shoe inserts can provide better arch support and help distribute pressure more evenly on the foot, reducing strain on the plantar fascia. A gait analysis is performed to evaluate walking patterns to help identify any issues contributing to plantar fasciitis.

Adjusting gait mechanics or recommending changes in footwear may be beneficial. Conservative physical therapy aims to improve symptoms, reduce inflammation, and enhance the foot’s biomechanics without the need for invasive procedures.

Orthotics:

Orthotics are shoe inserts designed to provide support, cushioning, stability, or correction to the foot. They can play a beneficial role in managing plantar fasciitis by addressing biomechanical issues, providing arch support, and reducing stress on the plantar fascia.

Many cases of plantar fasciitis are associated with insufficient arch support or improper foot mechanics. Orthotics with arch support, help distribute pressure more evenly across the foot, reducing strain on the plantar fascia and supporting its natural structure.

They offer shock absorption and offloading, which can help reduce the impact on the heel and the plantar fascia by redistributing the pressure during walking or other weight-bearing activities. This can alleviate pain and discomfort associated with plantar fasciitis.

It’s important to note that while over-the-counter (prefabricated) orthotics can offer support and relief for some individuals, custom-made orthotics prescribed by a podiatrist are specifically tailored to address individual foot structure, gait abnormalities, and biomechanical issues. Custom orthotics are designed based on a detailed assessment of the foot’s anatomy and function, providing a more personalized and precise solution for managing plantar fasciitis.

Shockwave:

Shockwave therapy, also known as Extracorporeal Shockwave Therapy (ESWT), is a non-invasive treatment that uses shockwaves to address various musculoskeletal conditions, including plantar fasciitis.

During shockwave therapy, a device delivers high-energy shockwaves to the affected area of the foot. These shockwaves are directed to the point of maximal tenderness along the plantar fascia, typically near the heel or arch of the foot. The shockwaves generated during the treatment session help stimulate the body’s natural healing response.

The shockwaves trigger increased blood flow, tissue regeneration, and a reduction in pain sensitivity in the affected area while reducing inflammation. Shockwave promotes tissue healing by disrupting abnormal tissue and encouraging the breakdown of scar tissue within the plantar fascia.

Shockwave therapy for plantar fasciitis is considered a safe and non-invasive option, generally well-tolerated by most individuals.

Night Splint:

A night splint is a device used in the treatment of plantar fasciitis to alleviate morning heel pain and stiffness by maintaining a gentle stretch on the plantar fascia and calf muscles while sleeping or relaxing.

Night splints are generally worn during sleep and are designed to keep the foot in a dorsiflexed (toes pointed upward) position, gently stretching the plantar fascia and calf muscles throughout the night. This prolonged stretch prevents the tightening or shortening of the plantar fascia, which often occurs during rest.

One of the characteristic symptoms of plantar fasciitis is intense pain and stiffness in the heel when taking the first steps in the morning. By maintaining the foot in a stretched position, night splints help prevent the plantar fascia from contracting overnight. Consequently, this can reduce the severity of morning pain and stiffness by minimizing the sudden strain on the fascia when standing up.

Night splints support the natural healing process by preventing the plantar fascia from tightening excessively during periods of inactivity. This prolonged, gentle stretch may aid in tissue repair and reduce inflammation by encouraging proper blood flow and preventing micro-tears that can occur with sudden stretching.

Night splints are often used in conjunction with other conservative treatments for plantar fasciitis, such as stretching exercises, physical therapy, and orthotic devices. They are considered part of a comprehensive treatment plan to alleviate symptoms and improve overall recovery.

Steroid Injections:

Steroid injections are sometimes used as a more invasive treatment option for plantar fasciitis, particularly when conservative measures have not provided relief from pain and inflammation. Steroids are strong anti-inflammatory medications which are injected directly into the affected area to help reduce inflammation and swelling within the plantar fascia.

This reduction in inflammation can alleviate pain and discomfort associated with plantar fasciitis. By decreasing inflammation, steroid injections may create an environment that promotes healing. By reducing swelling and irritation in the plantar fascia, the body may be better able to repair and regenerate the damaged tissue.

Steroid injections may be used as part of a comprehensive treatment plan alongside other conservative measures, such as orthotic devices, stretching exercises, physical therapy, and night splints.

It’s important to note that while steroid injections can provide significant relief for plantar fasciitis, they are not a cure and may have limitations. Injections may offer temporary relief, but they do not address the underlying causes of plantar fasciitis. Additionally, repeated steroid injections may increase the risk of potential side effects, such as weakening of tissues, fat pad atrophy, or potential damage to nearby structures.

The decision to use steroid injections for plantar fasciitis should be made in consultation with a podiatrist as they can evaluate your condition, consider potential risks and benefits, and determine the most appropriate treatment approach based on the severity of symptoms and the individual’s overall health

Surgical Plantar Fasciitis Treatments

Surgery for plantar fasciitis is reserved for cases where the pain and dysfunction significantly affect an individual’s quality of life, daily activities, and where other treatments have failed to provide relief. The percentage of plantar fasciitis cases that require surgery is relatively low, estimated to be around 5% -10%.

Surgery for plantar fasciitis is typically considered when conservative treatments have been exhausted, and the symptoms persist for 6–12 months without steady improvement. Several surgical procedures may be considered for the treatment of severe or persistent plantar fasciitis when conservative treatments have failed to alleviate symptoms.

If at all possible, we recommend minimally invasive surgical treatments for plantar fasciitis to speed up recovery, and improve post-surgery results.

Some surgical options for plantar fasciitis include:

Tenex (Minimally Invasive Procedure)
Plantar Fascia Release
Gastrocnemius Recession
Radiofrequency Microtenotomy (Minimally Invasive Procedure)
Endoscopic Plantar Fasciotomy (Minimally Invasive Procedure)

1. Tenex

Tenex is a minimally invasive surgical procedure used to treat chronic tendon or soft tissue-related conditions, including plantar fasciitis. The Tenex procedure aims to remove the damaged tissue causing chronic pain and inflammation in the plantar fascia while preserving healthy tissue. By removing the source of irritation, the procedure intends to promote healing and alleviate symptoms associated with plantar fasciitis, such as heel pain and foot discomfort.

2. Plantar Fascia Release

This is an open procedure where an incision is made along the bottom of the foot, and the plantar fascia is partially cut or released from its attachment to the heel bone (calcaneus). This aims to reduce tension and relieve chronic inflammation. As this is a more invasive procedure, it has fallen out of favor as highly effective minimally invasive procedures have been perfected.

3. Gastrocnemius Recession

This procedure addresses tightness in the calf muscles (gastrocnemius) which contributes to increased stress on the plantar fascia. Gastrocnemius recession involves lengthening the calf muscles surgically to reduce tension on the plantar fascia.

4. Radiofrequency Microtenotomy

Radiofrequency microtenotomy is a minimally invasive procedure that involves using radiofrequency energy to create small micro-incisions in the plantar fascia tissue. It aims to promote healing by inducing a controlled inflammatory response.

5. Endoscopic plantar fasciotomy

Endoscopic plantar fasciotomy is a minimally invasive surgery involving the use of an endoscope to visualize and release a portion of the plantar fascia through small incisions.
In the event surgery is needed to treat plantar fasciitis there are many options, most of which are minimally invasive and will have patients walking out of the operating room.

Conclusion

The effective management of plantar fasciitis requires a comprehensive approach that addresses pain relief, reduces inflammation, promotes healing, and prevents further injury.
Conservative treatments play a crucial role in the initial management of plantar fasciitis. For individuals who do not respond adequately to conservative treatments, more advanced therapies may be considered, including corticosteroid injections to reduce inflammation, shockwave therapy to stimulate healing, or in some cases, surgical interventions when other methods have been exhausted.
The optimal treatment plan for plantar fasciitis should be individualized based on the severity of symptoms, the patient’s lifestyle, underlying biomechanical factors, and the guidance of a podiatrist.
It is essential for individuals with plantar fasciitis to actively participate in their treatment plan, adhere to recommended exercises and therapies, and communicate effectively with their doctor to achieve the best possible outcomes and long-term relief from this debilitating condition.