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What is plantar fasciitis?

Plantar fasciitis is inflammation of the tough, fibrous tissue (plantar fascia) in the sole of the foot.  The symptoms usually begin as a dull pain in the heel that comes and goes,  then may become a more sharp, persistent pain.  The pain is usually more severe in the morning with the first few steps or after standing up from a seat after a period of rest.  The diagnosis of plantar fasciitis is based on the patient's history and careful clinical evaluation.  X-rays often reveal a bone spur, which is a result of the inflammation, not the source of the discomfort.  The bone spur is due to small tears in the plantar fascia with walking and daily activity.  The body heals these tears with fibrocartilage which then calcifies, giving the appearance of a spur on an X-ray.

What causes plantar fasciitis?

Plantar fasciitis is usually caused by a strain in the plantar fascia.  This strain can be due to pronation (flat feet), high arched and rigid feet, poor shoe support, sudden increase in weight, too much activity, or changes in activity or shoes.  

How is plantar fasciitis fixed or resolved?

Most of the time, patients respond to non-surgical treatments.  These include: rest, massaging the area, stretching, ice, anti-inflammatory medications, and some type of foot support or orthotic.  Orthotics are a somewhat rigid insert that help support the arch of the foot and prevent the plantar fascia from pulling too much. 

Patients in significant pain will usually need a series of cortisone injections, which are completely safe for most patients and can give up to 50% relief of symptoms in 48 hours.  Dr. Weiss will not give more than four injections within a six month period.

For patients who have sought conservative, non-surgical options and are still experiencing pain in the plantar fascia, Dr. Weiss may suggest having surgery to help alleviate the pain.  This surgery is called an endoscopic plantar fasciotomy (EPF).

What is an endoscopic plantar fasciotomy (EPF)?

This surgery is done to release a small portion of the plantar fascia to help alleviate some of the tightness around the heel area.  The EPF procedure is a 10-15 minute procedure done at the hospital and involves making a small incision, approximately a quarter-inch in size, on each side of the heel area. The procedure is done with a very small camera and requires one or two stitches afterwards.  Most patients are able to walk shortly after the surgery with use of a surgical shoe or boot.  Ice and elevation are important to reduce pain and swelling in the days following the surgery.  Approximately 85% of patients who had the EPF experienced complete relief of symptoms.  The remainder of the patients had moderate relief of symptoms and had to have additional treatment to relieve their heel discomfort.