Plantar Fasciitis: Understanding the Myriad of Treatment Options

If you’re struggling with chronic heel pain, it is quite likely that plantar fasciitis is the culprit. While the condition often occurs in athletes such as basketball players or runners, it can also impact other non-active individuals.

“A lot my patients hold a profession that lends itself to this type of injury,” says Dr. George Rivello, a podiatrist at Ridgecrest Regional Hospital. “A line cook or a correctional officer or a hairdresser—someone who is on their feet all day—they get that damaging repetitive stress just by standing in one place.”

Obese individuals also fall victim, because their body weight puts extra stress on the feet.

Quick to Diagnose

Plantar fasciitis is a musculoskeletal issue rooted in the structure of the bottom of the foot. “A band of connective tissue originates in your heel bone and divides into ten slips which go into your toes,” explains Dr. Rivello. “It kind of acts like a string across a bow, such that when you take a step down, the string stretches out.” When the structure experiences chronic tears, pain results.

Because plantar fasciitis is such a common condition, podiatrists and other orthopedic experts are typically quick to recognize it. “We can almost make the diagnosis in under a minute,” notes Dr. Rivello. Age of the patient and location of the pain—bottom of the foot, medial side of the heel—are almost always diagnostic certainties.

Additionally, patients often complain of a painful first step getting out of bed in the morning which gets progressively worse. “Typically this isn’t a rapid onset, meaning the patient rarely comes to us and says, ‘I was fine and then the next day I woke up and I had an incredible pain.’ It’s usually a slow, progressive onset without a history of any traumatic incident,” adds Dr. Rivello.

Uncovering the Best Treatment Option

In order to assess one’s condition, and what non-surgical treatments might work, Dr. Rivello observes his patients and asks investigative questions. “The first thing I look at, before the patient even comes in the room, is their footwear. I’m watching them walk down the hall with a flimsy pair of $3 drug store flip-flops, and I’m already identifying a problem,” he shares. “I also ask the patient some social questions, like are they training for an ultramarathon or did they just start a Zumba class.”

Modifying one’s activity and wearing a high-quality shoe with a supportive arch or an orthotic to support the arch can go a long way in addressing the pain. Dr. Rivello also advises patients to never walk barefoot, even in the home. “If you don’t like wearing shoes in the house, you can wear an orthopedic slipper to support your arch.”

Additional treatment options include specific stretching exercises and use of a night splint that holds the foot at right angles to the leg. While the patient sleeps, the splint stretches the structure to help diminish some of the pain experienced when taking that first step upon waking. A further step past bracing is to immobilize the foot with a controlled ankle motion (CAM) walking boot.

If improvement using these methods is not seen in about six weeks, Dr. Rivello considers a corticosteroid injection. “I’ve had really good success with a corticosteroid injection, and in fact, many times after that first injection patients start to improve and get back to normal.”

Should injections fail to provide relief, there are a few other therapies to explore prior to surgical intervention. Platelet rich plasma (PRP) injections, prolotherapy injections, extracorporeal shockwave therapy and more recently, stem cell injections are all potential options. “These are all on the ‘newer’ spectrum of treatments, with varying support in the medical literature. But, probably worth a try if that’s your last step before surgery,” advises Dr. Rivello.

Finally, when all else proves unsuccessful, surgery enters the conversation. “There are many approaches to surgery for plantar fasciitis, but I take an endoscopic approach,” explains Dr. Rivello. “I make a small incision on either side of the heel, insert an arthroscopic camera so I can visualize the plantar fascia band, and then release a third to a half of that structure to relieve the pressure and pain on the plantar fascia.”

While surgery is an available and effective solution, Dr. Rivello wants patients to know that only a very small percentage of those suffering gets to this point. “If we were to look at a pie chart and of all the people that I’ve seen for this problem, we are now talking about a very small slice of the pie,” he concludes.

Dr. George Rivello**To listen to an interview with Dr. George Rivello, a podiatrist at Ridgecrest Regional Hospital, follow this link: https://radiomd.com/ridgecrest/item/39565