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Plantar Fasciitis

    • The plantar fascia is a strong band of tissue that connects to the heel, and supports the arch of the foot. Plantar Fasciitis often is not related to a specific injury. Most plantar fascia injuries are a result of gradual wear and tear. Micro-damage over time can result in degenerative tears of the fascia and pain. Plantar fasciitis is the most common cause of heel pain, and most commonly occurs between ages 40 to 60 years.

    • Symptoms for plantar fasciitis include a stabbing pain felt on the heel or bottom of foot that often occurs with first steps in the morning. The pain normally decreases with initial movement, but may return after long periods of standing or standing up after prolonged sitting.

    • Diagnosis is based on detailed history, physical examination, and imaging. The area will likely be tender upon palpation. X-rays can be useful in showing heel spurs found in some cases of plantar fasciitis, but typically the spur is not the cause of pain. A magnetic resonance image (MRI) is often not necessary to diagnose plantar fasciitis, as diagnostic ultrasound provides detailed imaging of the tissue and may be used to identify abnormalities.

    • Conservative Management
      • Initial treatment of plantar fasciitis consists of rest, ice, NSAIDs, stretching, night splints and physical therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief and physical therapy may be utilized to improve flexibility, strength and function.

    • Shockwave Therapy
      • Shockwave therapy may be used as an adjunctive therapy for plantar fasciitis. Shockwave therapy initiates the body’s natural healing process with the aim of reducing pain and inflammation and increasing function.

    • Platelet Rich Plasma (PRP) Injections
      • PRP concentrates a patient’s blood to increase various growth factors. When injected into the injured plantar fascia it stimulates the natural healing response. Since chronic plantar fasciitis is a chronic process stimulating a healing response addresses the underlying cause of pain.

    • Ultrasound Guided Needle Tenotomy (TENEX)
      • Tenex is a minimally invasive procedure that can help eliminate chronic plantar fascia pain by precisely targeting and removing damaged tissue stimulating the healing process. Tenex has been shown to be helpful in cases of plantar fasciitis that have not previously responded to surgery (Razdan et al, 2019).

    • Surgical Intervention
      • Surgery is indicated when the plantar fascia does not respond to any non-operative interventions.

Razdan R, Vanderwoude E, Braun A, Morrey B. Percutaneous Ultrasonic Fasciotomy: A Novel Approach to Treat Chronic Plantar Fasciitis. J Surg Proced Tech. 2018.