Plantar Fasciitis

Plantar fasciitis is a common cause of heel pain in patients, affecting approximately 2 million people every year. The plantar fascia is a band of tissue that runs from the tip of the big toe all the way to the heel. It supports the arch of the foot and absorbs most of the stresses we place on our feet.

On average, a person will take about 10,000 steps each day. Even though our feet can take a lot of stress as we move around throughout the day, overuse can cause inflammation or the plantar fascia may tear where it attaches to the heel.

At Seaview, our board-certified foot and ankle surgeons, Dr. Aron Green, Dr. Eric Beights, and Dr. George Fahoury, frequently see patients with plantar fasciitis. We offer both surgical and nonsurgical treatment options for plantar fasciitis.

Symptoms of Plantar Fasciitis

It is estimated that heel pain affects about half of the U.S. population at some point during their lives. The most common symptom of plantar fasciitis is heel pain that occurs within the first few steps of getting out of bed in the morning. This is because the foot typically relaxes into a pointed position when we sleep. This shortens the length of the plantar fascia, causing pain in the morning when the plantar fascia is stretched to a normal, extended position. Additionally, if the plantar fascia is torn, it may create scar tissue overnight in that shortened position. When you step out of bed in the morning, that scar tissue can tear, causing pain.

Heel pain may also occur after a long period of rest. Plantar fasciitis pain typically improves with activity during the day, but may return at the end of the day or after a period of strenuous activity or use.

Risk Factors

There are several factors that can increase your chances of developing plantar fasciitis, including:

  • Tight calf muscles can make it difficult to flex the foot fully, shortening the plantar fascia over time
  • Obesity
  • Having a very high arch
  • Repetitive impact activity (running/sports)
  • New or increased activity
  • Having a flat foot

Doctor Examination

During your examination, your doctor will ask you to describe your symptoms and discuss your concerns. Your doctor will aslo examine your foot, looking for any of the following signs that are consistent for the diagnosis of plantar fasciitis:

  • A high arch
  • Tenderness on the bottom of your foot, just in front of your heel bone
  • Pain when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down.
  • Limited “up” motion of your ankle

Tests

Imaging tests, such as x-rays, may be ordered for you to make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones, so they are useful in ruling out other causes of heel pain, such as fractures or arthritis.

Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are rarely ordered as a diagnostic for plantar fasciitis. However, if initial treatment methods do not relieve your heel pain, your doctor may order an MRI scan for further evaluation of your problem.

Treatment Options for Plantar Fasciitis

In the majority of cases, plantar fasciitis will resolve within a year to 18 months with conservative treatment. However, surgical options are also available if conservative treatments are not effective at relieving heel pain.

Conservative Treatment

Conservative treatment for plantar fasciitis involves the use of a night splint to hold the foot in an extended position while the patient sleeps. This can help to alleviate heel pain in the morning. Shoe inserts or custom orthotics may be recommended to help cushion the heel and reduce heel pain caused by standing or walking. Topical or oral anti-inflammatory medications may also help to improve heel pain throughout the day.

Physical therapy is very beneficial for patients with plantar fasciitis. Physical therapy focuses on stretching the plantar fascia and calf muscles to lengthen the tissues and improve range of motion. At Seaview, we offer physical therapy services on-site for the convenience of our patients.

Massage therapy can also be helpful for patients with plantar fasciitis. The Graston technique, a process in which the plantar fascia is massaged with specially-designed instruments, can help to break up scar tissue and promote the formation of healthy tissue.

Minimally Invasive Treatment

If conservative treatments do not relieve pain, more aggressive treatment options may be recommended. The latest treatment options for plantar fasciitis are minimally invasive and can help patients avoid or delay the need for surgical procedures.

Platelet-rich plasma injections are thought to stimulate healing in the plantar fascia because platelets contain proteins called growth factors that are integral to the healing process. During this procedure, the patient’s blood is placed in a centrifuge to separate the platelets from the rest of the blood cells. The highly-concentrated platelets are then injected into the injured plantar fascia to promote healing. Amniotic allograft injection can also be used to treat plantar fasciitis.

High energy ultrasound may also help to alleviate the symptoms of plantar fasciitis. Percutaneous ultrasound-guided needle tenotomy, a treatment in which a needle is inserted into the tissue to create small holes and increase circulation to the area, is also effective for some patients. The needle is driven under ultrasound guidance, just like it is done for a corticosteroid injection into the plantar fascia.

Surgical Treatment

If conservative and minimally invasive treatments do not relieve a patient’s pain, surgery may be recommended. Your orthopedic surgeon will work with you to determine the best option for you.

Endoscopic surgery for plantar fasciitis is possible, but it carries a higher risk of complications than open surgery. Endoscopic surgery may not address the full problem at the heel.

Open surgery for plantar fasciitis may involve a partial cut in the plantar fascia to relieve tension. Typically, the tissue is resected in the middle of the plantar fascia, leaving the outer bands of tissue intact to prevent the development of a flat foot. The abductor muscle may also be released to prevent Baxter’s nerve entrapment, which can cause pain. If heel spurs are present, they are typically removed during the procedure to prevent potential irritation.

Plantar Fasciitis Treatment in Jersey Shore and Central New Jersey

Our foot and ankle surgeons, Dr. Aron Green, Dr. Eric Beights, and Dr. George Fahoury, have over 35 years of combined experience in treating conditions like plantar fasciitis. Our foot and ankle specialists are available at all six office locations, and we offer physical therapy on-site for your convenience. If you would like to learn more about our services or schedule an appointment, please call (732) 660-6200. We are happy to help!