Plantar fasciitis: Conservative treatment or surgery?

What is plantar fasciitis and what does it consist of?

The plantar fascia is an anatomical structure formed by connective tissue located on the sole of the foot, under the subcutaneous cellular tissue. This structure plays a very important role in the biomechanics of the foot, supporting the internal arch, turning the foot into a rigid lever for propulsion during walking and providing natural cushioning when walking.

When we talk about plantar fasciitis we refer to an inflammatory process of the fascia, usually at the level of its insertion in the calcaneus (heel bone). When this picture exceeds 3-4 weeks of evolution becomes chronic, called plantar fasciosis, which is caused by a failure in the process of tissue repair becoming a degenerative and non-inflammatory condition.

Plantar fasciitis usually causes a stabbing pain when stepping on the plantar heel area, with the pain being worse at the beginning of the day and after periods of rest (“cold pain”).

Causes of plantar fasciitis

The occurrence of plantar fasciitis/fasciosis is due to multiple factors. Several of the reasons that cause it are:

  • Structural and biomechanical alterations.
  • Overweight
  • Shortening of calf muscles
  • Dysymmetries (legs of different lengths)
  • Excessively flat shoes

Diagnosis of plantar fasciitis

To make a good diagnosis it is important that the specialist in Podiatry perform a thorough anamnesis, emphasizing the time of evolution of the injury, and a complete exploration of the lower limb, relying on complementary tests such as ultrasound, which will help us to identify what state is the plantar fascia.

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Existing treatment options

We differentiate the treatments into two types: conservative and surgical.

  • Conservative treatments: It is of vital importance to detect:
    1. What type of fasciopathy we are facing: acute (fasciitis) or chronic (fasciosis).
    2. Cause of the fasciopathy: for this way to be more precise in the treatment.

Conservative treatments range from: Physiotherapy, stretching, realization of plantar supports (custom insoles) and medication, infiltrations (corticosteroids, collagen, PRP, etc.).

  • Surgical treatments: Surgical treatment is resorted to when conservative treatments have failed after 6-12 months, never before. Most procedures are aimed at reducing tension on the plantar fascia and promoting the repair process (partial fasciotomy, TOPAZ, etc.).