One of the most common problems in the foot is plantar fasciitis. This condition will lead to a painful often sensitive heel that is stiff in the morning or after sitting. It is caused by an inflammation of the plantar fascia. This fascia is the soft tissue on the bottom of the foot which supports the bony arch and is involved in the push-off portion of walking. Weight problems, working on hard surfaces, a high arch in your foot, and new impact activities are often associated with the start of the condition. Many times, no particular cause is noted as the condition can be initiated by simple degeneration of the plantar fascia.
A bony spur is seen in some heels with the condition, though it is often seen in those without the pain. The spur is not the problem, but a reaction in the muscle under the fascia to the inflammation. Although the condition is quite painful and often limiting, conservative care should lead to a resolution of the problem in months. If conservative care fails, a steroid injection in the foot can be done. When done correctly pain of the injection can be minimized. If an injection, or a series (up to 3 injections can be performed), surgery can be a good option. In the surgical procedure, we release 2/3s of the plantar fascia through a small incision in front of the heel pad skin. Initially, you elevate for 2-3 days, recheck the wound at a week from surgery and begin weight bearing. Most people are full weight bearing by 2 weeks after surgery using a walker boot for support as needed and increasing activity as tolerated.
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