Plantar fasciitis is the term we use to describe the disabling pain which is felt on the inner aspect of the heel. The pain starts gradually and is rarely associated with an injury. The pain is always felt on the inner aspect of the heel and tends to be worse first thing in the morning and last thing at night. Typically, patients who suffer this problem report being unable to walk when they get out of bed but notice an improvement in the pain as the foot warms up during the day. After resting in the evening, the pain often returns. Rest is commonly associated with increasing pain.
For a long time, this pain has been attributed to heel spurs (hence the name). Unfortunately, the heel spur, when it is present, is not the cause of the pain. Many patients with plantar fasciitis don’t have a spur. Treatment consisting of physiotherapy, anti-inflammatory tablets prescribed by your Family Doctor, massage, stretches, orthotics (insoles for the shoes) and even exercises to rub the sole of the foot over a rolling pin or bottle to “stretch” the plantar fascia are generally tried. The only problem with any stretching exercises is that you are attempting to stretch tissue whose normal function relies on it not being able to stretch at all. If it did stretch, the arch of the foot could collapse. As with any condition when many alternative treatments are available, it often does not respond to any of them. This explains why there are so many treatments. Many patients fail to experience any relief with any or all of them and give up in frustration.
If you have had any or perhaps most of these treatments and are no better, you have fallen into that group of patients whose pain is due to plantar fasciitis. This term describes the tissue which is affected by this condition. In fact, it is not really an inflammation of the tissues but a degeneration of them. The pain, which is often severe, as mentioned above is always on the inside are of the heel. There is considerable local tenderness when the area is pressed and this can make walking very difficult. The first few steps in the morning are always very painful.
On the sole of your foot there is a very tough membrane which runs from the heel to the toes and helps to support the arch of the foot. This acts rather like the spring in a car suspension. Over time, this tissue, which is subject to a lot of day to day stress, becomes worn out and some of the microscopic fibres, which constitute it, break down. The body tries to heal the tissue and creates scar. It is the change in the elasticity and strength of this tissue which causes the pain. There is a simple and obvious reason for this condition to develop. When we take our next step, the heel strikes the ground with a force which can be much more than double our weight. If we take on average 1,000,000 steps each year, it would not come as a surprise that the foot tissue in some individuals wears out and breaks down. Sometimes an x-ray of the heel reveals a “heel spur”. It is important to note that this spur does not actually cause the pain and many individuals have a large heel spur and no pain associated with it and many people with severe plantar fasciitis do not have a spur.
When the tendon is torn, Cortisone and oral medication can only help the pain but don’t specifically deal with the problem. This explains why so many of the conservative treatments result in such a disappointing degree of long term pain relief. If all of these treatments have failed, the pain can very reliably be relieved by our operation.
Operations for plantar fasciitis have always had a bad reputation and with good reason. Most procedures described cut the plantar fascia. Any operation that cuts the plantar fascia disturbs the mechanics of the foot. This can result in the later development of troublesome lateral foot pain. Our operation is specifically designed to preserve normal foot mechanics and is directed at dealing with the degeneration of the plantar fascia. This is done under anaesthetic in a hospital operating room through a 2-3 cm incision over the inner aspect of the heel and off the weight-bearing skin. A dissection in the heel is made and specific details of exactly what is done are discussed at the time of your consultation. Because this makes the heel quite sore for a day or so, a long acting local anaesthetic is used to relieve the pain after the operation enabling you to go home the next day after a complete dressing change.
All operation can have complications and this is no exception. The most common complication is post-operative pain which is lessened by the local anaesthetic injection into the heel and bleeding from the wound. The next most common problems are minor wound problems and DVT. This is a very safe operation.