If you haven’t heard of plantar fasciitis, you are one of the lucky ones. Plantar fasciitis is one of the most common ailments we see in the office. 1/3 people will experience the condition in their lifetime.

Plantar fasciitis can be a painful and frustrating condition. However, with appropriate treatment and lifestyle modifications, most people will resolve the condition and be able to resume their normal physical activities. 

Symptoms seen for plantar fasciitis is pain on the bottom of the heel (not on the back of the heel as seen with Achilles tendinitis). It can be described as a sharp or stabbing pain on the bottom of the heel which can be quite tender when arising after being seated for a period of time. Most notably in the morning when first getting out of bed. The discomfort usually increases with activity. Mild swelling may be present.

Diagnosis is made mainly through the patient’s description of their pain and the physical exam. X-rays may be used to rule out other boney conditions, and in fact, the presence of a heel spur is not the source of the problem since it has been known for decades that the spur is an incidental finding. Diagnostic ultrasound is a simple and effective way to diagnose plantar fasciitis and can be performed in the office setting where available.

Upon identifying plantar fasciitis as the problem, conservative treatment can include some or all of the following: anti-inflammatory medication, oral steroids, steroid injections, supportive insoles, appropriate shoe gear, night splints, calf and foot stretching and physical therapy.

In rare instances surgery may be suggested when conservative treatment over several months has failed. The most common surgical procedures address the unhealthy soft tissue of the plantar fascia ligament (ie. Endoscopic Plantar Fasciotomy, Ultrasound Guided Fasciotomy). It is NOT recommended to remove the bone spur on the bottom of the heel as the spur is not in the plantar fascia ligament but in a tendon attachment.  

Seek professional healthcare advice if your heel pain has not resolved on its own in 4 weeks.

Endoscopic Plantar Fasciotomy             

Ultrasound Guided Fasciotomy

About Seth Steber, DPM, FACFAS, CWSP