Case Studies In Treating Chronic Plantar Fasciitis
At 18 days post-op, the patient presented with left calf pain that began the previous night. A physical examination revealed pain, swelling and tightness in the left gastrocsoleus complex. I immediately referred the patient to a vascular specialist and he diagnosed deep venous thrombosis (DVT). The vascular specialist prescribed enoxaparin sodium (Lovenox, Sanofi Aventis) and his DVT completely resolved with no further sequelae. At three months postoperatively, the patient had returned to all activity including running with no pain or symptoms in the left foot and a one-year follow-up visit revealed no symptoms with pain-free activity.
The in-step fasciotomy has the advantage of avoiding the neurovascular bundle and allows excellent visualization of the fascia the surgeon is transecting.11 Not allowing weightbearing for three weeks postoperatively does increase the risk of a DVT and one should consider prophylaxis, especially in those patients who have any risk factors.
The treatment of plantar fasciosis is not always predictable but it is important to develop a protocol that is sensible and consistent to allow the practitioner to determine which treatment works best. Anecdotally, I have found that the sooner one initiates conservative treatment, the more successful one is in resolving the pain. As with most pathology, the treating physician must address the potential causes and not focus solely on treating the symptoms.
Dr. Fullem is in private practice in Tampa, Florida. He is board-certified in foot surgery by the American Board of Podiatric Surgery and board-certified in foot orthopedics by the American Board of Podiatric Orthopedics and Primary Care Medicine. Dr. Fullem is a Fellow of the American Academy of Podiatric Sports Medicine (AAPSM) and is currently organizing the AAPSM’s first stand-alone conference in almost 20 years. The conference will take place March 14-16, 2014 in Tampa, Fla. For more info, e-mail Dr. Fullem at email@example.com .
1. Taunton JE, Ryan MB, Clement DB, et al. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med. 2002;36(2):95–101.
2. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004;25(5):303–310.
3. Wolgin M, Cook C, Graham C, et al. Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int. 1994;15(3):97–102.
4. O’Brien D, Martin WJ. A retrospective analysis of heel pain. J Am Podiatr Med Assoc. 1985;75(8):416–418.
5. Scherer PR. Biomechanics Graduate Research Group for 1988: Heel spur syndrome: pathomechanics and nonsurgical treatment. J Am Podiatr Med Assoc. 1991;81(2):68–72.
6. Lynch DM, Goforth WP, Martin JE, et al. Conservative treatment of plantar fasciitis: a prospective study. J Am Podiatr Med Assoc. 1998;88(8):375–380.
7. Saxena A, Fullem B. Plantar fascia ruptures in athletes. Am J Sports Med. 2004;32(3):662-5.
8. Saxena A, Fullem B. Plantar fascia injuries. In: Altchek D (ed): Foot and Ankle Sports Medicine, Lippincott Williams and Wilkins, Philadelphia, 2013, pp. 301-315.
9. Aksahin E, Dogruyol D, Yüksel HY, et al. The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis. Arch Orthop Trauma Surg. 2012;132(6):781-5.
10. Aqil A, Siddiqui MR, Solan M, et al. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs. Clin Orthop Relat Res. 2013 Jun 28. [Epub ahead of print]
11. Boberg J. Plantar fascia surgery in master techniques. In: Chang T (ed): Master Techniques In Podiatric Surgery: The Foot and Ankle, Lippincott, Williams & Wilkins, Philadelphia, 2004, pp. 222–224.