Current Concepts In The Algorithm For Plantar Fasciitis

Patrick DeHeer, DPM, FACFAS, and Kellie Higgins, DPM

   Surgeons have routinely performed gastroc recessions to treat isolated contractures of the gastrocsoleus complex. However, literature has shown that a tight gastroc leads to excessive strain of the foot. This excessive strain can lead to plantar fasciitis. A gastroc recession specifically addresses the equinus deformity known to cause plantar fasciitis. A study by Maskill evaluated 29 patients (34 feet) who had undergone six months of conservative treatment with no relief.21 These patients had an isolated gastrocnemius rescession. Postoperatively, 93 percent were satisfied with the procedure and their pain reduction.

   The instep procedure is well documented as a successful surgical treatment for plantar fasciitis. In one study, researchers retrospectively evaluated 83 patients (94 feet) who had an instep plantar fasciotomy.22 All patients had received extensive conservative treatment without pain reduction. After the procedure, 93.6 percent of patients considered their surgery successful. The main complications were scarring in 9.6 percent of patients, medial arch pain in 7.5 percent of patients, cramping in the arch in 6.4 percent of patients and lateral column pain in 5.3 percent of the patients.

   In another study, Woelffer and co-workers conducted a five-year follow-up of the instep plantar fasciotomy.23 They looked at 33 surgical cases and found that 90.9 percent of patients had over 90 percent satisfaction and 81.8 percent of patients had over 90 percent pain relief. In a study by Brekke and Green on the plantar fascia release, they reported a 71.4 percent satisfaction rate with the main complication of the surgery being lateral foot pain.24 Overall, the instep procedure has a low complication rate and researchers have shown that it reduces patient pain significantly.

In Conclusion

Plantar fasciitis is becoming more prevalent in today’s population and patients want relief. Getting the patient’s pain reduced or resolved, using NSAIDs or oral corticosteroids, and addressing the equinus deformity with stretching and strapping are the first steps in successful treatment. When further invasive procedures are necessary, consider using injections, PRP, shockwave therapy and surgery to help patients quickly and painlessly return to their daily activities.

   Dr. DeHeer is a Fellow of the American College of Foot and Ankle Surgeons, and a Diplomate of the American Board of Podiatric Surgery. He is also a team podiatrist for the Indiana Pacers and the Indiana Fever. Dr. DeHeer is in private practice with various offices in Indianapolis.

   Dr. Higgins is a first-year resident at St. Vincent’s Hospital in Indianapolis.

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