Jan
2014

Q&A: I'm suffering from Plantar Fascititis for four years, how can I end this?

Ask A Doctor Question: 

I have been diagonses with Plantar Fascititis. I work 9-12 hrs a day on my feet whole time,i have been in pain for the last 4 years but the last 8months to a year have been escrusiating pain. If I am not off my feet enough to let my feet rest and get better, wouldnt surgery be a better option to fix this, I think going on for 9 more months with this pain that i have felt for 4 yrs and always being on my feet with my occupation is crazy before surgery would be thought of, so pay this doctor lots of money for all the visits and cortizone shots until the time comes, WHY?????

- Steve

Answer: 

Howard R. Fox, DPM, FACFS - LocateADoc.com

Steve,
 
Four years is a long, long time to be having plantar fasciitis.  How certain are you and your doctor that this diagnosis is accurate?  Was an MRI or at least a sonogram done?  You may have a tear in your plantar fascia, and you may even have a stress fracture of your heel bone.
 
We now know for certain what works and what doesn’t work for plantar fasciitis (assuming this is what’s really going on).  The two most successful treatments are injections and wearing a night splint (to keep your foot at 90 degrees when you sleep).  We’ve even found plain lidocaine injections without the cortisone work almost as well as with a steroid.
 
The next two things that work second-best are stretching exercises for both your foot and your calves, and wearing some sort of orthotic in your shoe.  There is overwhelming data now that shows cheap over-the-counter arch supports actually work better than custom made orthotics!  The soft gel rubbery things don’t work.  You need a very firm, hard arch to help.
 
What we know doesn’t work is physical therapy, shock wave treatments and oral anti-inflammatory medication.
 
Surgery works, and it’s now done through a ¼ inch incision on the bottom of your heel to just simply cut the plantar fascia.  It takes about 30 seconds and there is little disability.  HOWEVER, before you consider surgery (or any more shots), you really need an accurate diagnosis.  In my 35 years of practice, I have had only ONE patient with plantar fasciitis for over 4 years, and I’m STILL doubting my diagnosis on her.
 
Hope this helps.  Good luck!

--Howard R. Fox, DPM, FACFS
718-987-5366
Staten Island, NY

Answer: 

Stephen Lasday, DPM - LocateADoc.com

Plantar fasciitis can be be extremely painful and can linger a long time.  Its caused by abnormal pulling or stress that causes a chronic inflammation or degeneration within the fibers of the fascia.  
 
Understand that I am answering your question without the benefit of examining you, but in short, it sounds like surgery is an option for you.  You have had this pain a long time, and non surgical methods aren't working.  If you are on your feet so much, a custom orthotic may be needed.  I am not clear if you have one or not.
 
I treat fasciitis initially with stretching exercises, both active stretches and with something called a plantar fasciitis night splint, which your doctor may have or you might find one on the internet.   
 
Shots are helpful but rarely curative.
 
A properly fitted total contact orthotic is the best treatment in my opinion, and I have seen greater than 93% pain relief in 3 months.
 
Surgery is not without risks and complications, and should rarely be a first choice.
 
The May/June 2013 issue of the The Journal of Foot and Ankle Surgery has an article that discusses a traditional from of surgery for fasciitis versus an instep fasciotomy through a small incision.  The study concluded that the instep procedure resulted in better pain relief and less complications.  
 
I prefer the instep fasciotomy when I do this surgery.  Other methods include an endoscopic technique, which I have also done, but the instep procedure in my opinion is preferable.  It still would require almost a month of down time if you are on your feet all the time at work.
 
Patients and doctors need to be comfortable with each other and the treatment plan.  I always offer my patients a second opinion with another local doctor, and other doctors do so with me.  Its a nice way to have another opinion without any concerns on either party.  Sometimes the other opinion helps me rethink my approach.
 

--Stephen Lasday, DPM
Sarasota, FL

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