Early attention key to avoiding aggressive surgical options

Imagine getting out of bed every morning and feeling a temporary pain shoot through your heel. For many people, this is an everyday occurrence. Heel pain, an inflammation of a thick band of tissue that connects the heel bone to the toes, can start as a minor annoyance that people deal with for months before being properly identified as plantar fasciitis—a condition that one in 10 people will suffer from in their lifetime (1).

The condition manifests over time and is often attributed to normal wear and tear, but heel pain of this type can have serious repercussions if not treated promptly and properly by a foot and ankle surgeon.

Greg Catalano, DPM, FACFAS, a Massachusetts foot and ankle surgeon and Fellow member of ACFAS, states that options for heel pain are becoming more advanced and focused on helping the patient’s body heal the injury itself.

According to ACFAS foot and ankle surgeons, depending on the severity of a patient’s plantar fasciitis, these latest treatment options can include:

• Injection Therapy: Foot and ankle surgeons use growth factor injections and platelet rich plasma (PRP) injections to boost the body’s healing response to help repair the injured band of tissue causing the pain.
   
• Shockwave Therapy: This in-office treatment uses sound waves delivered over the skin to slightly damage the tissue and stimulate the body’s natural repair process. This helps the plantar fasciitis heal and relieves pain symptoms without making an incision. Patients can expect to be up and moving immediately after the treatment, but it may take three to six months to see the results.
   
• Ultrasonic Treatment: This procedure is a newer treatment option where foot and ankle surgeons make a small incision into the heel of the foot and use a probe to direct ultrasonic energy at the fascia to break down bad tissue and help the healing process. A diagnostic ultrasound tool is used to create an image of the inside of the foot and to guide the probe. Patients may need to wear a boot immediately after the procedure for up to two weeks and they can expect to see improvements anywhere from three to six months after the procedure.
   
• Surgery: Also called a plantar fasciotomy, this procedure is a minimally invasive and minimally traumatic surgical treatment where the foot and ankle surgeon makes a small incision through the heel into the damaged tendon to try to lengthen it and relieve some of the tension. Patients tend to recover in six to 10 weeks, but it may take up to three months to resume exercise and more vigorous activities.

Heel pain that is present for more than four weeks and has not responded to changes in support or anti-inflammatory medications are signs it is time to seek help. According to Jason Miller, DPM, FACFAS, a Pennsylvania foot and ankle surgeon and Fellow member of ACFAS, if the heel pain is interfering with normal daily activities, work or recreational activities, then it is time to see a foot and ankle surgeon.

When visiting a foot and ankle surgeon, patients need to be honest about how their pain developed, their level of activity, what type of shoes they wear and what type of treatment they have completed, if any. Foot and ankle surgeons will look to conservative treatments first, such as stretching exercises, icing, modifying shoe gear and activity and sometimes physical therapy. They may also recommend using a night splint or a cortisone injection for patients who experience chronic pain in the morning.

“A lot of patients will get better with conservative therapy if done correctly,” said Dr. Miller. “The good news is that, for patients who don’t respond well to conservative approaches, we have more treatment options than ever before.”

1. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85-A:872–7. [PubMed]