What is it?
Plantar fasciitis is a debilitating pain under the heel that comes on suddenly and can really affect sports and even general mobility. The plantar fascia is initially tight and inflamed but with time becomes worn and abnormal. My assessment focussed on underlying causes such as tight calves and I am careful to rule out any concerning problems such as a lump inside the heel bone which can mimic this common condition
Why causes it?
The most common cause is tight calves but being overweight and having poorly controlled diabetes also contribute. When I assess you I will go through all of the causes and ensure we treat the underlying cause so it improves and does not come back.
How can I treat it?
Initial treatment is best if we use a number of different strategies. I start with a bespoke stretching programme supervised by a specialist foot and ankle therapist, I arrange for some insoles to protect your feet and if morning pain is a real issue, I arrange for some night splints to maintain your foot in a better position whilst you sleep. If the pain doesn’t settle within 8-12 weeks, I ask the specialist physiotherapist to give you a course of shockwave therapy which is a non invasive ultrasound wave which is successful in over 80% of cases.
For the small number of patients who are still having symptoms I am trialling a new form of biologic injection for which I have been awarded a £15000 grant to research.
This injection is a single shot injection which can help the fascia to heal. I normally do this as a quick day case procedure under anaesthetic as the injection can be a bit painful if you are awake.
What does surgery involve?
If all the above measures are not successful, I use a very modern keyhole camera technique where using 2 small incisions I clear the bone spike from under the heal bone and fully visualise the plantar fascia. I then release the inflamed fascia from the inside half of the bone.
Whereas open plantar fascia release had a very long recovery, this minimally invasive technique is done as a day case and you can walk on the day of surgery in a bandage. I take the bandage down after 10 days and you restart stretching exercises. You should be back to normal activities by 2-3 months.
Risks and complications
There are risks to all surgery and conservative measures should be tried when possible. If surgery is an option, we will discuss all of the pros and cons and the risks that are specific to you in detail. Specific risks of this procedure are-
There is a small risk of injury to the nerve at the inside of the foot. To avoid this I use blunt dissection and only use motorised instruments when I am in a safe space.