PLANTAR FASCIITIS OR ‘TENNIS’ HEEL
Plantar fasciitis is one of the most common causes of heel pain. It involves pain and inflammation of a thick band of tissue, called the plantar fascia.
Plantar fasciitis commonly causes pricking or diffuse pain that usually occurs with morning’s first step. Once you start walking, after some distance the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.
X-ray Copyright Kapil Bakshi “bakshiortho.com”
Plantar fasciitis is particularly common in people who are overweight and those who wear heavy safety shoes with inadequate support are at risk. Faulty foot mechanics contribute.
CAUSE: Repetitive traction, ageing could produce micro tears and cystic degeneration in the origin of plantar fascia.
Specific Questions asked
a. Where is the pain?
b. Is it always in the same place?
c. Is it worse with the first few steps in the morning?
d. Does it go away with rest?
X-Ray may reveal a calcaneal bony spur in 50% when the problem is chronic over time. The spur is initially asymptomatic mostly, the inflammation around it causes pain. This inflammation is visible with an Ultrasound.
HD Ultrasound defines quantum of inflammation, precise area of affection and gives guidance for precision targeted injections as required. MRI is positive in 76%, it rules out other pathologies like fascial tears, calcaneal edema and arteriovenous malformations.
Treatment: Most people who have plantar fasciitis recover with conservative treatments in just a few months. Ultrasonic or Wax therapy therapy may be helpful. When unresponsive to treatment they should be treated with locally acting Ultrasound guided corticosteroid injections, the drug is not water soluble as it is in the ACETATE form, is not absorbed into the blood stream immediately but does so over time. It is stated to be in “DEPOT” form, benefits outweigh the other effects, hence it is NOT harmful.
In severe cases, the quantum of inflammation is seen on ultrasound it is wiser to inject first before physiotherapy to reduce the morbidity period. In mild to moderate cases physiotherapy can be initiated first.
Ultrasound guidance targets the maximally inflamed area with precision and better clinical results than just targeting the tenderness.
Surgery: Plantar fasciotomy, Plantar Fascia Release of central core: Resection of Medial wedge of fascia: Neurolysis of 1st branch of lateral plantar nerve: Removal of Calcaneal spur: Decompression with multiple drill holes in calcaneus & Release of Flexor Digitorum Brevis are options. These procedures are options to be discussed with patients in intractable cases.