Treatments of Plantar Fasciitis
Many patients get better with the help of non-medical treatments. Stretches for the calf muscles take tension off the plantar fascia and is one of the most effective treatments. A night splint may be worn while sleeping which keeps the foot from bending downward, and places a mild stretch on the calf muscles and the plantar fascia. Symptoms seem to get better faster when using a night splint. Supporting the arch with well fitted orthotics, may also help reduce pressure on the plantar fascia. Using a special type of insert into the shoe, called a heel cup, can also reduce the pressure on the area and add padding to a heel that has lost some of the fat pad through the ageing process. Shock wave therapy is a newer form of non-surgical treatment and applies shock wave pulses to the sore area. Patients receive the treatment once each week for up to three weeks. Anti-inflammatory medications are also used to decrease the inflammation in the fascia. Cortisone injections into the area of the fascia has also been shown to be of benefit. Cortisone should be used carefully since it may contribute to the process of degeneration of the fat pad, making the problem worse.
Surgery should only be done as a last resort.
Possible surgeries can include:
- Removal of the bone spur (if present)
- Release of the plantar fascia (must be done)
- Release pressure on the small nerves in the area
Usually the procedure is done through a small incision on the inside edge of the foot often using an endoscope. An endoscope is a small camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. This allows the surgeon to complete the process with a smaller incision. Surgery usually involves identifying the area where the plantar fascia attaches to the heel and partially releasing the fascia from the bone. If a bone spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves.
Patients with Plantar Fasciitis will often undergo physical therapy. Therapists design exercises to improve flexibility in the calf muscles and the plantar fascia. Treatments directed to the area help control pain and swelling (ultrasound, ice packs, and soft-tissue massage). Therapy sessions sometimes include a mild electrical current to push anti-inflammatory medicine to the sore area. A customized foot orthotic may be designed to support the arch of the foot and to help cushion the heel or the therapist may recommend the use a heel cup. A night splint may also be required while sleeping.
It will take several weeks before the tissues are well healed. The incision is protected with a bandage or dressing for about one week after surgery and crutches will likely be required. The stitches are generally removed in 10 to 14 days. Physiotherapy may then be advised.