What is plantar fasciitis?
The plantar fascia is a band of thick fibrous connective tissue that runs from the heel to the toes forming the “string” of the arch of the foot. It helps transmit energy with each stride when running or walking.
The area of greatest stress is located at its insertion in the calcaneus, at the level of the heel. Plantar fasciitis is the inflammation that occurs when the thick band becomes too overloaded or suffers micro-tears, causing heel pain or pain in the sole of the foot when walking or running, which is especially noticeable in the first steps after getting up.
We can perform imaging tests such as ultrasound to assess the plantar fascia which may in these cases be thickened, degenerated or with a small tear. Sometimes a calcaneal spur has formed at the insertion of the fascia.
In chronic cases or with diagnostic doubts we also recommend MRI.
What is the cause of plantar fasciitis?
This injury is common in athletes, mainly runners. In sedentary people it can occur due to excess weight, muscle weakness of the foot, altered foot support, pes cavus and shortening of the calf among others.
The onset is usually progressive or insidious, if it is acute we must suspect partial rupture of the fascia.
Treatment for plantar fasciitis
Initially the treatment should consist of unloading the foot, reducing the time of running and walking. If there is inflammation, local cold may be applied.
Physiotherapy should consist of manual therapy of the entire plantar calcaneal achilles system (it is important to treat the calf and soleus muscles and toe flexors).
In our opinion, tecartherapy treatment is the first choice when available. The physiotherapist can also use dry needling.
The evolution is usually slow and if the treatment is not taken seriously, the process can become chronic. When this happens we can try other therapeutic alternatives. Corticosteroid infiltrations are a possibility in case of a lot of pain or local inflammation, but they should not be repeated if they do not work and in no case more than three times.
Treatment with extracorporeal shock waves is not invasive and is a good alternative if the patient does not show improvement after a few months.
Platelet-rich plasma injections can be used in situations where there is a partial tear of the plantar fascia. In our experience, this is an effective technique in this class of patients. An infiltration is usually performed every 1-2 weeks, preferably ultrasound-guided and after a previous imaging study to assess the appropriateness of this treatment.
A novel alternative is to treat the medial and inferior calcaneal nerve with radiofrequency. It can be reserved for rebellious cases or in which a more important neural component is suspected.
If none of the above treatments are successful we can consider some surgical options that may cure the patient:
- Percutaneous treatment with a radiofrequency terminal (topaz microdebrider). We perforate the fascia in its pathological and degenerated zone, obtaining the stimulus for the healing of the process.
- Plantar fasciotomy: It consists of partially or totally releasing the fascia in the insertion area, where the damaged area is located. It is usually performed percutaneously.
- Calf lengthening: in patients in whom a shortening of the internal calf muscle that causes excessive tension on the fascia is the objective. It is a simple intervention, in which the tendon of the internal calf is sectioned through a small incision in the popliteal area.
In case of failure of all the previously mentioned options, an open exposure of the area and total or partial fasciotomy must be performed, in addition to the release of the nerve branches that may be affected by the chronic process.
To recover the normal life a progressive recovery is given, in no case immediately. Runners who have undergone surgery return to running after about 6-8 weeks, but it may take a few months before they can train at the highest level.
To learn more about plantar fasciitis contact a specialist.