Point-Counterpoint: Should We Do Plantar Fascia Releases For Heel Pain?
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For a related article, see the November 2011 DPM Blog, “Resistant Plantar Fasciitis: Why We Should Opt For A Gastrocnemius Recession Before Even Considering A Plantar Fasciotomy,” by Patrick DeHeer, DPM, FACFAS at http://tinyurl.com/8wl5kuy .
Noting that he rarely needs to perform plantar fascia releases, this author says conservative methods are still effective and one must exhaust them before taking a surgical approach to heel pain.
By Steven Shannon, DPM, FACFAS
Plantar fasciitis and plantar heel pain are very common problems in most of our practices. People who present with the symptoms vary widely in their activity levels, shoe gear, body type, age, gender and occupation.
In light of these variations, a wide variety of non-surgical treatments are available for plantar heel pain. As we all know, stretching exercises and arch support therapy are the first-line treatments for this very common ailment. In addition, many other modalities are not far behind if the patient does not respond. Rest, ice, immobilization, nonsteroidal anti-inflammatory drug (NSAID) therapy, cortisone injections, night splints, physical therapy, exercise modification, custom-molded orthotics and shoe changes can all be very appropriate therapies. In addition, modalities such as platelet-rich plasma (PRP) injections, prolotherapy and extracorporeal shockwave therapy (ESWT) have all entered the arena as non-surgical options to treat plantar heel pain.
Generally speaking, I have found the conservative approaches to plantar heel pain usually will yield at least a 90 percent success rate if not higher. This leaves a very small percentage of cases that become recalcitrant to conservative approaches. Even taking into account these recalcitrant cases, research has shown that other forms of treatment, including ESWT and PRP injections, have a beneficial effect and can relieve a significant number of these difficult cases.1,2 What this leaves is a very small percentage of people who do not respond to a non-surgical approach.