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Plantar Fasciitis
Description
Plantar fasciitis is an inflammation of a thick, fibrous ligament in the arch of the foot called the plantar fascia. The plantar fascia attaches into the heel bone and fans out toward the ball of the foot, attaching into the base of the toes. If this ligament is stretched excessively it will become inflamed and begin to cause pain. In severe instances, the ligament can rupture resulting in immediate severe pain. If the ligament ruptures, the pain is so great that the patient can not place weight on the foot. Should this happen, the foot should be elevated and an ice pack applied. An appointment with your foot doctor should be made at your earliest convenience. Sports such as tennis, racket ball, and aerobics can cause extreme tension on the plantar fascia resulting in small tears or rupture of the ligament. However, other less stressful activities can result in tears or rupture of the plantar fascia under the right set of circumstances. (For a more through discussion of the cause of plantar fasciitis see heel pain). One consequence of small tears in the plantar fascia is the formation of firm nodules within the plantar fascia, called fibromas.
Diagnosis
Taking a through history of the course of the condition and physical exam makes the diagnosis of plantar fasciitis.
Treatment
Treatment of plantar fasciitis is similar to that for heel pain. Cortisone injections, used in the treatment of heel pain, are not commonly used for the treatment of plantar fasciitis. The main emphasis of treatment is to reduce the forces that are causing the plantar fascia to stretch excessively. This includes calf muscle stretching, over-the-counter arch supports, and oral anti-inflammatory medicine may be useful in controlling the pain.
 Dr. Aung is excited to also offer a new treatment, Extracorporeal Shock Wave Therapy, for chronic plantar fasciitis "heel pain". Extracorporeal" means "outside the body". Shock waves are created by very strong acoustic (sound) energy. Your ESW treatment will be performed with a device called the OssaTron. The OssaTron is a shock wave generator very similar to the shock wave devices used to treat kidney stones without surgery. The shock waves are created by a spark plus that is enclosed in a soft plastic dome filled with water. During ESW treatment, this dome is placed close against the heel so that the shock waves pass through the dome to the heel. ESW treatment has recently been found to be effective for treating chronic proximal plantar fasciitis.
Surgery to correct heel pain is generally only recommended if orthotics or the OssaTron treatment have not been successful. A new endoscopic treatment for heel pain is now available from Dr. Aung. This new method uses an endoscope which is a small camera instrument that allows the surgeon to see "anatomy" inside the body. By using a very small incision, less than ½ inch, this new procedure releases the extreme tension on the plantar fascia which is the cause of the pain in the majority of cases. All of this is viewed on the television monitor by the surgeon. The procedure itself usually takes less than 10 minutes using a local anesthetic. A sterile dressing is worn for approximately 3 days and then the patient is usually allowed to return to regular shoe wear. Minimal loss of work is incurred.
There are some exceptions to this course of treatment and it is up to you and our office to determine the most appropriate course of treatment. Following surgical treatment to correct heel pain the patient will generally have to continue the use of orthotics. The surgery does not correct the cause of the heel pain. The surgery will illuminate the pain but the process that caused the pain will continue without the use of orthotics. If orthotics have been prescribed prior to surgery they generally do not have to be remade.
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