Heel Pain- Plantar Fasciitis
You have been directed to this section of the website because you have been diagnosed with plantar fasciitis. This is inflammation of the plantar fascia, which is a long ligament-like structure that runs along the bottom of your foot from the heel bone into the base of your toes.
Plantar fasciitis is a very common complaint affecting at least 10% of the population. It is seen on a daily basis in Mr McCallum’s practice. The condition normally resolves within 9 months regardless of whether or not it is treated. It is classified as a chronic condition when it has been present for longer than 6-months and unfortunately in these cases, the symptoms can be more stubborn. In rare cases, the symptoms cannot be cured.
Causes:
There is no single known cause of plantar fasciitis. Most likely, the condition is brought on because of a combination of factors such as:
- Tight calf muscles.
- Biomechanical factors.
- Overweight or recent weight gain.
- Prolonged use of flat shoes or sandals.
- Sudden injury.
- Recent increase in activity levels.
- Prolonged periods of standing or walking
Diagnosis:
Mr McCallum will normally be able to diagnose the condition after taking a detailed history of the complaint and performing a clinical examination. In cases where the presentation is atypical, an ultrasound or MRI scan may be requested.
Treatment Options:
Unfortunately there is no quick fix for plantar fasciitis and the treatments are based around things you can do at home.
Home Treatments:
- Calf stretches- These are fundamental in the treatment of plantar fasciitis and there is an abundance of support for this in research that has been carried out for plantar fasciitis. The photo below shows a calf stretch board. Mr McCallum will demonstrate the correct technique for performing these exercises.
- Ice massage- Freeze a bottle of water and roll your foot over the top of this in the evening for 10-minutes.
- Insoles/Orthoses- Supporting the arch of the foot reduces the strain on the plantar fascia. These devices also prevent the foot from rolling in excessively (excessively pronating), which in itself causes increased tension on the plantar fascia. Often an over the counter device is adequate although if Mr McCallum feels that your foot mechanics are a significant contributing factor to your condition then you will be offered a more custom made set of devices.
- Supportive, laced up footwear- Slip-on, people who suffer from plantar fasciitis commonly use unsupportive or flat shoes despite the fact that these have a tendency to worsen the problem. A laced up supportive running shoes with a well-cushioned sole is generally recommended. Often a shoe with a small heel can help as this alleviates some of the tension in the calf muscles and in doing so, can help reduce symptoms.
- Night splints- These hold your foot in a such a position so that the calf muscles are under a continuous stretch. These can be effective but many patients do find them difficult to tolerate in bed.
- Weight loss- A large portion of patients with plantar fasciitis are over weight. A weight loss programme can be very effective in alleviating symptoms of plantar fasciitis.
- Painkillers or anti-inflammatory medication- These can be effective in the short term but are not recommended in the long-term treatment of plantar fasciitis.
Clinical Treatments:
- Steroid injections- These have an anti-inflammatory effect, which can help, reduce the pain in your heel. It is common for the injection to make the pain worse for a few days before it starts to improve. Painkillers can help reduce this discomfort. Steroid injections alone are rarely effective in curing the problem.
Surgical Treatment:
This is reserved for patients who have not gained adequate relief from conservative care. Mr McCallum advises that surgery is used as a last resort as the success rates following surgery are 50/50 at best.
The surgery involves a small incision on the inside of your heel through which the plantar fascia is cut and released. You will be placed into a walking boot for a period of 4-weeks. Even in cases where the heel pain is improved after the surgery, some patients then go on to experience pain elsewhere in their foot- often along the outside edge.
Possible Complications:
Outlined below are the possible problems or the rare complications following foot surgery with serious outcomes. In cases where there are no accurate audit results, published results from podiatric literature have been used.
- Prolonged swelling taking more than 6-months to resolve can occur in 1 in 500 operations.
- Haematoma- a painful collection of blood under the skin. This can increase the risk of developing an infection and may require further surgery to resolve.
- Thick or sensitive scar.
- Adverse reaction to the post-operative painkillers. 1 in 50 patents report that codeine preparations make them feel sick.
- Infection of the soft tissue. 1 in every 83 operations.
- Infection of bone- osteomyelitis. This is a serious complication and in severe cases, can lead to amputation.
- Delayed healing of soft tissue or bone.
- Circulatory impairment with loss of tissue.
- Loss of sensation can occur although this is not normally permanent and can continue to improve over 18-months.
- Deep vein thrombosis (blood clot) can result in the clot travelling to the lung and this can be a life threatening condition. Deep vein thrombosis incidence is 3 in 1000 cases.
- Complex pain syndrome- a condition where the nervous system dealing with pain over reacts. This is a very painful condition that can result with even with minor trauma. It normally requires management by specialists in this condition and does not always resolve. This is a rare condition that occurs in 3 in 2500 cases.
- Recurrence of deformity or failure of the surgery.
The risk of developing a complication can be minimised when the patient and all those concerned with the operation and aftercare work together. This starts with the pre-operative screening and continues through to the post-operative regime.
The pre-operative screening helps us determine whether you are fit for surgery or if any extra measures need to be considered to minimise your risk of developing a complication. It is important that you disclose your full medical history. If there is a query regarding your health then further investigations may be required and Mr McCallum will liaise with the appropriate medical specialists. Mr McCallum and the there team will ensure that your operation is carried out safely and effectively.
You can improve your healing process and reduce the risks by:
- Adhering to the post-operative instructions, which include resting and elevating the operated foot. Keeping the wound dry and clean until advised otherwise. Please ask Mr McCallum if you are not sure what to do.
- Having a healthy diet is important; this provides the nutrition required for healing.
- Alcohol can interact with the drugs that are prescribed and can impair wound healing.
- Post-operative mobilisation will be advised; this helps improve flexibility, strength and stability of your foot.