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Plantar Faciitis (Heel Pain)
Pain in the heel is one of the most common problems that a foot specialist treats. The actual cause of heel pain can be contributed to a variety of factors. Most often with conservative treatment, patients can be relieved of their symptoms without the necessity for surgery. The development of heel pain can be a slow insidious process, and therefore, the recovery can take months as well. Forces on the heel exerted by the muscles and ligaments that support the arch of the foot can contribute to the development of heel pain. One of the most common conditions that can cause heel pain is referred to as plantar fasciitis. Plantar fasciitis pain is typically worse in the morning, but tends to get better throughout the day, and then gets worse again after being on the feet all day. Individuals with high arches or a tight Achilles may be more frequently affected. Those who are overweight, run very long distances, or participate in high impact activities may also have a higher incidence of plantar fasciitis. A heel spur is sometimes seen on x-ray and can be associated with plantar fasciitis.
Surgery may be beneficial if other treatments fail. The aim of operative intervention is to release the tight fascia, relieve nerve pressure, or to do both. The recovery process from plantar fascia release can take a few months. Much of the time immediately after surgery is spent resting and elevating your foot to decrease swelling. Most patients are discharged home the day of surgery in a splint, which will be converted to a cast in the office. Stitches are generally removed around 2-3 weeks. We request that you avoid placing weight on your foot during the first six weeks and use crutches, a walker, or a rolling knee scooter to aid with mobilization. Patients are generally transitioned from a walking boot into a regular shoe with an arch support at about 8-12 weeks after surgery.
Plantar fasciitis is generally a self-limited process, but it can take a long time to resolve. The treatment can be tailored according to the duration of symptoms and the degree of pain. Conservative treatment is successful in the vast majority of patients. Only rarely do plantar fasciitis patients require operative intervention. Anti-inflammatory medications in combination with Achilles tendon and plantar fascia stretching will usually relieve the condition. A night splint to keep the foot in a neutral position while you sleep has been shown to be very beneficial. High heels and restrictive footwear can exacerbate the condition. A cushioned athletic shoe with a good arch support is imperative. Sometimes custom foot orthotics can be beneficial if patients have no relief with an off-the-shelf arch support. Avoid walking barefoot as much as possible. If the problem persists despite trying these things, then a steroid injection may be beneficial. After an injection, sometimes patients are placed in a walking boot, as injections have been associated with plantar fascia ruptures.
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