The plantar fascia is a strong ligamentous band which originates on the sole of the foot and is attached to the calcaneal tuberosity in the heel, extending along the sole of the foot to provide slips to all 5 toes. It helps to support the arch of the foot.
Plantar fasciitis occurs in adults and is the most common cause of heel pain, is typically aggravated by activity and relieved with rest. It is an inflammatory process of the fascia.
The vast majority of patients will improve with non-surgical measures.
Plantar fasciitis is an irritation of the plantar fascia. This thick band of connective tissue travels across the bottom of the foot between the toes and the heel. It supports the foot’s natural arch. It stretches and becomes taut whenever the foot bears weight.
- Non-operative Measures:
- Topical pain creams e.g. NSAIDS
- Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
- Footwear modification: athletic shoes, stiffer soled shoe with rocker bottom modification
- Physiotherapy with plantar fascia and achilles tendon stretches
- Plantar fascia exercises e.g. rolling the foot on a frozen water bottle or rolling the foot on a tennis ball
- Activity modification: improve fitness and strength via non axial loading exercises e.g. cycling, swimming. Avoid axial loading exercises e.g. running
- Off the shelf or custom orthotics
- Night splints
- Silicone heel pads (obtain at running shoe stores)
- CAM boots may be required to rest the fascia
- Weight loss management
- Shockwave therapy may help
It is expected the symptoms will improve after 6-12 months. If not, surgery is occasionally required.
This may include release of the fascia via keyhole methods or open release with an incision on the inside or medial aspect of the heel.
- The expected post-operative recovery is:
- Ice and elevate as much as possible in first 10 days
- Removal of sutures 10 days post surgery
- Weight-bearing in a CAM boot for 3-4 weeks
- Then progress to normal shoe wear and gradually increase activities by 6 weeks post surgery. Depending on activity, sports may be resumed 12 weeks after surgery.
- Surgery Risks
All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:
- Infection: superficial wounds or deep infections
- Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
- Nerve damage: tingling, numbness or burning
- Ongoing pain
- Stiffness of the ankle joint
- General or anaesthetic risks including to the heart and lung
- Drug reactions/allergy
- Scarring or tethering of the skin
- Calf weakness
- Revision surgery
- Increased risk of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery
- Post Op Guides
- Ankle Arthrodesis
- Ankle Arthroscopy
- Ankle Fracture
- Calcaneal Fracture
- Flatfoot Reconstruction
- Hallux Rigidus – Arthrodesis
- Hallux Rigidus – Arthroplasty
- Hallux Valgus Surgery
- Lapidus Procedure
- Lateral Ligament Instability
- Midfoot Arthrodesis
- Midfoot Fractures Surgery
- Subtalar Joint Arthrodesis
- Tibiotalocalcaneal Fusion
- Total Ankle Arthroplasty