Plantar Fasciitis Treatment: High-Tech Alternatives That Work
Posted by Jenn F. on Friday, March 23rd, 2018
Plantar fasciitis is one of the most common conditions we treat at The Center for Podiatric Care and Sports Medicine. Nationwide, arch and heel pain account for up to 15% of all podiatrist visits—that’s 1 million Americans suffering from the condition. This type of pain is striking in that it tends to afflict patients worst after a night of sleeping or period of rest. In recent years, we’ve grown to understand this condition much better. It’s not just a matter of chronic inflammation—but rather, degenerative changes to the fascia that cannot be ignored. Here in the office, we employ a number of high-tech treatments for plantar fasciitis that work tremendously.
Diagnosing Heel Pain
Before we delve into the high-tech alternatives to surgery that work in treating heel pain, you should know that proper diagnosis is a crucial first step. A foot and ankle specialist like those employed at The Center for Podiatric Care and Sports Medicine have all the necessary tools and expertise to enhance your outcome. We assess factors like foot structure, tightness of the posterior muscle group, past history of overuse injury, and degenerative changes in our physical exams.
Radiographic assessment can help us rule out fractures, tumors, bone cysts, and subcalcaneal or retrocalcaneal spurs. Ultrasound may reveal thickening or tearing of the fascia and bone spur or hypoechoic mass formation. MRI supports complex cases to reveal the source of nerve problems and the extent of edema.
We will need to differentiate plantar fasciitis from a number of conditions that present similar symptoms, such as:
- Tarsal tunnel syndrome/nerve entrapment
- Heel bursitis
- Stress fractures
- Soft tissue tears
- Growth plate inflammation
Unlike the emergency room or a general practitioner whose goal is to mitigate your immediate symptoms—we do that certainly, but also seek to identify the root cause of your trouble. Only then can we come up with a reasonable recovery regimen. That said, conservative therapy helps anywhere from 70 to 90% of patients who have had symptoms for up to three months. About 50% of chronic cases (six months or longer) will respond to first-line measures. Only 30% of those with pain for over a year respond to conservative therapy. If you fail to progress, you’ll be happy to know we offer advanced heel pain treatments to move you along nicely.
First Steps In Plantar Fasciitis Treatment
- Footwear Selection: Wearing the right shoes is critical for patients with heel pain. Often, a custom-molded orthotic device can provide substantial improvement. Believe it or not, in some cases, that is all that a patient truly needs.
- Stretches: Learning a few personalized stretches with a physical therapist can work wonders when done regularly, too.
- Corticosteroids: It was once widely believed that corticosteroid injections could provide immediate pain relief by reducing inflammation. However, we now know the underlying problem is degenerative changes, not inflammation. Reviews have been mixed, with some studies finding pain relief for up to a month, and others finding no relief whatsoever. More troubling, one review identified two ruptures of the plantar fascia, three injection site infections, and 27 accounts of less serious adverse effects. We use this type of injection therapy sparingly—less than 10% of the time—when a bridge therapy is needed before other conservative measures provide relief.
Advanced Therapies For Heel Pain
When you need something more, we can offer that like few others in the NYC region.
- Extracorporeal shockwave therapy: Shockwave therapy stimulates natural wound healing, collagen generation, and pain reduction. When compared to low-level therapeutic ultrasound’s 23.5% improvement rate, 65% of the shockwave patients showed a clinical response. Equally positive results are observed, whether patients are in the early or late stages of plantar fasciitis. We prefer to use low dose Extracorporeal Shockwave Therapy sooner in the sequence of treatment if possible.
- Platelet-rich plasma injections: A study of 40 patients with chronic plantar fasciitis who did not respond to conservative therapy after four months found superior healing rates (of 70% or higher) with platelet-rich plasma, an extract derived from a patient’s own blood that is spun to enhance the concentration of growth factors and cytokines. Pain relief is usually noted at three months, but the response continues for as long as 12 months. Patients usually spend a few weeks in a boot after injection and resume normal activities within two weeks. Virtually no complications are observed with treatment, so it has become a hallmark of therapy among providers who have invested in the equipment.
- Cryopreserved human amniotic membrane: Human fetal tissue contains a plethora of beneficial growth factors. Research shows statistical foot pain relief by 18 weeks with one or two injections and no adverse reactions reported. This treatment is still fairly new and considered experimental by insurance providers, so we don’t prescribe it as often. Usually, a single ultrasound-guided injection is needed, with a possible second injection administered in one to three months. Patients rest in a boot for two weeks after the therapy and receive instructions on how to massage the area for comfort. Cold therapy is avoided. Normal activities are resumed within two weeks.
When Patients With Plantar Fasciitis Need Surgical Solutions
A very small portion of patients needs surgical intervention for plantar fasciitis. Whenever possible, we prefer minimally invasive procedures that clean up degenerated tissue and encourage natural repair mechanisms, such as the minimally invasive microfasciotomy, Topaz percutaneous radiofrequency microdebridement, or Tenex percutaneous ultrasonic microdebridement.
When all other therapies fail, the endoscopic or open plantar fascia release can provide relief. One can perform the release of the plantar fascia, either endoscopic or open. Endoscopic gastrocnemius resection is the most common intervention, with open partial plantar fascia release with nerve decompression the second most common. Surgery patients typically spend three weeks in a boot before getting back to routine activities shortly thereafter.
If you live in the NYC metro, contact us to explore your full set of options.
If you have any foot problems or pain, contact The Center for Podiatric Care and Sports Medicine. Dr. Josef J. Geldwert, Dr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.