What is Plantar Fasciitis?
Plantar Fasciitis is the most common cause of heel pain in adults. It describes the inflammation of the plantar fascia (“itis” means inflammation in Latin). The plantar fascia is a tough band of tissue that connects the heel bone to the toes. It gives the arch of the foot support and helps you walk. It can get weak and inflamed if you strain it, which causes pain as you walk or stand.
The condition can occur in both younger and middle-aged people. It is common in soldiers and athletes, and pretty much everyone who is on their feet a lot. The causes are different, it could be that:
- You are overweight
- You are exposed to prolonged standing, running, or walking
- You have flat feet
- You have excessive pronation (the arch collapses due to weight bearing, which causes your feet to roll inward excessively)
- Your calf muscles or Achilles tendons are tight
- Your shoes don’t fit well
- You have high arches
Symptoms
The main symptom is sharp pain and stiffness on the bottom of your heel, usually after prolonged rest or activity. However, you may also experience foot burning, tingling, and pain when flexing. Limping is possible as well.
The discomfort is usually worst in the morning, starting right after getting off the bed, and becomes a nagging pain throughout the whole day. Some people may have heel spurs or suffer no symptoms at all. Patients who suffer from this condition are advised to seek plantar fasciitis treatment as soon as possible to avoid increasing pain and daily inconvenience.
Assessment
At HC Orthopaedic Surgery, we will take a thorough history, radiological investigations, and physical examination to exclude other causes of heel pain, such as stress fractures, referred pain or nerve entrapments. Then, we will recommend a suitable treatment method for plantar fasciitis.
The tests that are typically requested in this case include:
- X-rays. This is a photographic image that helps to check the condition of your organs and many other things inside the body. It comprises an electromagnetic wave that has short wavelength yet high energy.
- CT (computed tomography) scan. This one enable doctors to look inside your body and see if something is wrong. It employs a combination of multiple X-rays, which means it’s better and more detailed than a regular X-ray device. The test can be done anywhere on your body.
- MRI (magnetic resonance imaging). This is a more advanced type of machine that tracks down the physiological processes of the body by delivering images of the patient’s anatomy. It employs both radio waves and strong magnetic fields to get the job done.
Non-Operative Methods
Depending on the severity, plantar fasciitis treatment in Singapore is individualized and can be divided into:
- Night splints
It might feel highly uncomfortable to sleep with a gadget wrapped around your foot and ankle, or both limbs for that matter, especially something bulky. However, if you wear a splint at night, you may notice improvement in your condition. Once the pain wears away, you are free to let go of them. The need to use arch supports is present in other ailments too and although it’s not the most amazing treatment in terms of comfort, it is worthwhile. - Protective shoe inserts and insolesThey are designed to provide your feet with the comfort and relief they deserve. When you have a health condition like this, each step you make poses a huge shock to the foot. Protective insoles take the stress away and support your arch. Other than plantar fasciitis, they are effective for bone spurs too.
- Anti-inflammatory drugs
Sports medicine and over-the-counter medication like ibuprofen minimise irritation and get rid of the burning pain. Your doctor will prescribe the right dosage as well as the timeframe in which you should take the pills. - Stretching exercises
You may need to visit a physical therapist if ice packs and rest don’t produce the desired results. They will use ultrasonography, contrast baths, and massage to improve your chances of healing. They will also show you how to strengthen and stretch your lower leg muscles, Achilles tendon, and plantar fasciitis. This will go on for months, but it’s likely to work. Yet, if you don’t experience any improvement in your condition, you may be referred to a orthopaedic surgeon. - Cortisone injection
It should be noted that this does not treat plantar fasciitis but it can alleviate the symptoms. Steroids are known to lower inflammation which in turn reduces the pain. Cortisone is one such drug that is typically used in these cases. It can help with other health conditions too such as flat feet. - Joint injection (Plasma)
The patient is injected with a portion of his or her own blood which has been enriched with platelets so that the concentration is much higher than what it normally is. This works to heal injured joints, muscles, and tendons. First off, the plasma is extracted from the person, then it’s centrifuged and inserted into the abnormal tissue. The injection may be guided using ultrasound. The greatest advantage of this treatment is that it is not likely to produce any side effects due to the fact that the patient is receiving their own blood. Once the session is over, a specialist will design a strengthening and stretching programme to help with the healing. - Extracorporeal shock wave therapy
According to some studies, this treatment might help with chronic plantar fasciitis, however, the results haven’t proven to be consistent. Not to mention, it may cause tingling, numbness, swelling, and bruising. During the procedure, sound waves are sent to the troubled area. It basically works by stunning the affected tissue and the nearby nerves, which stops the pain.
Surgery Methods
Study findings reveal that every 9 out of 10 people respond well to non-surgical treatments, hence an invasive procedure ought to be considered only after all other methods have been tried and tested. The purpose of plantar fasciitis surgery is to reduce the tension and inflammation that have occurred in the foot. It can be different types.
- Open and endoscopic surgery
Open: the expert makes an incision either at the bottom or at the back of the heel where the thinner skin meets the thick sole. For endoscopic procedures, the incision is made on one side of the heel. Then, the bone and the fascia will be separated from one another. In addition, the surgeon might want to smooth the bone a bit or remove part of the tissue.
When the treatment is over, the patient needs to wear a cast for 2-3 weeks to minimise tension and speed up healing. Depending on the type of incision made, they may or may not begin light weight-bearing right away.A rehab and flexibility programme will be a part of your everyday life for as long as necessary. You will need to restore muscle strength before you can go back to your normal activities.
It has to be said the success rate of such interventions is calculated to be approximately 70-80%, this is why doctors always suggest that conservative treatment is tried first.
The recovery takes between six and ten weeks. - Radiofrequency ablation
This is energy that is passed onto the skin to heat a small fraction of the troubled tissue and remove sensory perception. It works by disrupting the myelin sheath of the nerve. Technically speaking, it creates gaps in the plasma membrane, which stops the nerve conduction and decreases pain signals in that particular site.
In order for the doctor to localise the problematic nerves, they need to determine which areas experience the biggest tenderness. They numb the foot, insert an electrode into the tissue, and deliver an electrical current into it. Most devices come with built-in timers, which means the heat generated to the skin is controlled. This saves the surrounding tissue from being burned and reduces downtime. The patient should feel the difference almost immediately.
