WHERE DOES IT HURT ?
Plantar fasciitis is an injury or overuse syndrome involving the Plantar fascial ligament in the arch of the foot that runs from the ball of the foot to the bottom of the heel. This band of tissue is protective to the deep structures of the foot and is not a primary stabilizer of the archway.
The pain is characterized as sharp with the first few steps in the morning and also in the evening after increased activities or with minor relief as it is “warmed up” during light walking and massage.
Watch our surgery video, listen to patient experience with our custom molded orthotics, learn about conservative treatments.
Crutches and non-weight bearing on the affected foot for 1 to 3 weeks is the best care for this kind of overuse syndrome or injury, but a simple decrease in activities may relieve symptoms. Avoid bare feet and shoes without support (sandals, flip-flops, house shoes, etc.).
Static stretching in the morning AND evening using the proper technique will speed recovery and minimize re-injury.
Anti-inflammatory medication can help with the chronic pain, but are not much help with the acute pain.
An anesthetic (numbing agent) mixed with cortisone (anti- inflammatory) is placed at the point of pain to relieve the sharp pain associated with the first few steps in the morning and/or pain at night after increased activities.
Temporary arch supports, supportive athletic shoes, or a higher heel on a shoe will all provide additional rest to the injured ligament. Custom molded orthotics is the best solution for immediate and long term treatment.
A night splint is a device that keeps a constant tension on the ligament while it is healing by keeping the foot at a 90 degree angle to the lower leg.
Examples of physical therapy include massage, cold therapy, contrast baths, stretching, ultrasound, and electric stimulation.
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Enhanced Healing with Stem Cell Treatments
Several effective procedures exist, but releasing the Plantar fascial ligament near the heel with or without removing an existing heel spur will essentially lengthen the ligament and provide permanent relief. The incision is minimal (1cm to ½ inch) at the inside of the heel and sutures are removed at 2 weeks.
The procedure is performed in an outpatient facility under sedation and partial weight bearing is allowed after 48 to 72 hours of non weight bearing.
Treatment options for this common foot problem.
First and foremost are the plethora of conservative care - non surgical options for Plantar fasciitis and heel spur pain. About 70% of the patients in our office will have immediate relief with injection therapy and then permanent relief from both heel and arch pain with Custom Molded Orthotics. The material of the orthotic is materially important. Thermo-molded polypropylene, fiberglass, and other flexible materials are tolerated better and can be used for both work and exercise.
Injection therapy is most common. On the first visit, typically utilizing cortisone to decrease the morning pain. There are other healing injections, such as PRP (see reference about new platelet rich plasma procedure) and the new human amnionic cellular implants (see reference) can be used also. Make no mistake though, rest is the most effective treatment and top athletes will use crutches for a severe case or injury. And that is what Plantar fasciitis, especially the chronic form, is - an overuse syndrome or injury, arch strain, sprain, etc.
Rest, ice, and also very important is stretching. Stretching the Plantar fascia with one leg back and the knee straight in the morning (30 seconds each leg) and before bedtime is now the standard treatment as well as for treating nocturnal 'night cramping'. Longer periods of stretching can be achieved with night splints that can be ordered online, and a removable cam walker at times can minimize both the amount of stress on the foot and propulsion portion during a normal walking gait.
Many new treatments have sprung up over the last 20 years. High intensity sound waves, radio frequency, and deep tissue manipulation are options before surgery and have a decent success rate. Surgical procedures have a high success rate, but this varies of course with the surgeon and variety of minimal invasive vs. 'open' procedures. The good news is that they are usually performed in a small procedure room or out patient surgical center under a light anesthesia. The procedures are relatively short and post operative period averages 1-2 weeks with partial weight bearing with or without a cam walker - post operative shoe.
What you should know if you have pain in the arch of the foot.
Arch pain is something that patients come in for fatigue and it’s connected with the ball or the heel or just the central portion. In short, it’s something that patients are coming in with, knowing the diagnosis called Plantir Fasciitis. This ligament, is just a bow string. If the arch drops, the bow string is going to get tight. And, if it’s pulled enough through exercise or lack of support in the shoes, it can cause a burning pain, some pain in the morning with your first few steps. But, don’t lose the fact that this type of injury or overuse syndrome will not heal unless you have the proper support and the proper rest.
With that in mind, we have options with injection therapy which is an anti-inflammatory cortisone to get rid of the pain immediately and we have permanent arch supports that are molded to your feet so they’re accustomed to support the surface and create the arch in a more neutral position to relax the ligament to not only heal the problem, but keep it from coming back.
Dr. Moore discusses some common types of pain in the ball of the foot and the best treatment options:
The ball of the foot is an interesting area. It’s not only a lot of pressure per square inch where you have a complete flat surface but then when you take just one little concentrated area and you put all of your body weight on there all day or for my female patients, you vault the foot forward and the high heel puts more pressure on the ball of the foot, you have a more intense pain.
That being said, the bones or knuckles you can feel right here on the ball of your foot, if they’re not sore enough, there is another condition called a neuroma which is a nerve branch between the two heads and that can become swollen, irritated or pinched.
The good news with this area is that there are several conservative options like cortisone injections to shrink up these nerve masses or calm down the ball of the foot pain temporarily. We can use orthotics or arch supports that simply put more pressure in the arch to alleviate just the foot hitting the ball and heel portion, so, it fills in the gap and takes the pressure off the ball of the foot. Then, we can discuss different types of shoe gear to get the patient by or actually cure the problem.
I have one patient that came in and she had multiple problems with the ball of her foot and she had been seeing other surgeons and was signed up to have surgery and we simply gave her a few injections, and put her in orthotics and the pain went away.
On the flip side, I had another patient who had tried everything and was about to have some type of new laser procedure performed and we did an MRI and saw that the actual size of the nerve mass was huge and there was a ganglion or fluid filled sack associated with that so hers was a little more complicated and the removal that we performed gave her 100% relief so I recommend that these problems get the full conservative attempt but also the testing is fully performed afterwards if the problem is not resolved to make sure that the right problem is being fixed.
This video is about Custom molded orthotics - Patient testimonial. A hard working construction worker who had painful feet and Plantar fasciitis was looking for more than the usual arch supports. The thermo molded polypropylene devices are casted with the feet in what is called the 'neutral position' to help lock the foot and arch in it's natural position. more on custom orthotics
These are links to more information on the subject, not intended to imply an endorsement.
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Our doctors have extended specialist medical training focused on the foot, ankle and lower leg. We are board-certified surgeons and experts in delivering care for complex foot and ankle disorders as well as cosmetic or reconstructive procedures and problems related to sports injuries and other medical conditions.
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