TREATMENT OF HEEL PAIN AND PLANTAR FASCIITIS

(a)    Taping.  Athletic tape can be applied to the planar fascia and works by reducing tension by preventing the fascia from over stretching.  Tension is maintained by the tape thus allowing the fascia to rest and heal.  The tape is strapped from the heel to the base of the digits. 

(b)    Orthotic treatment.

(c)    Silicone heel cups.  Product providing pressure relief to the heel spur cavity with a well designed heel cup may reduce localised discomfort.  It increases the absorption of the impact at heel strike allowing the heel area to be in virtual suspension at heel strike. 

(d)    Rest.  Decrease any strenuous activity, sports and long walks allowing for the inflammation of the plantar fascia to decrease however it may also lead to increased discomfort upon resumption of activity if the biomechanical factors have not been addressed.

(e)    Stretching.  Tightness of the plantar fascia occurs if the achillis tendon and calf muscles are tight.  Tightening in these muscle groups increases the dorsiflexion of the hallus which stretches the plantar fascia causing it to inflate.  Plantar fascia type stretching.  Patient crosses affected foot over the other leg, grasps the base of the digits and pulls the toes back towards the shin until a stretch in the arch is felt.  This stretch is held for approximately 10 seconds and repeated.  Three sets of 10 repetitions are performed daily.

(f)    Corticosteroid injections.  Limited evidence supports the use of corticosteroid injections into the plantar fascia.

(g)    Surgery.  Surgery for plantar fasciitis is a last option resort after all else has been tried for the patient.  Success rates have been quoted as low as 34% and as high as 60%.  Endoscopic plantar fasciotomy is a difficult procedure and requires a podiatric surgeon.  While the procedure takes approximately 30 minutes and can be performed as day surgery appropriate injections to anesthetise the foot are required.  Two small incisions are made either side of the heel medially and laterally.  A tube is inserted into the plantar fascia and an endoscopic camera is used to cut the fascia which relieves the tension.  New fascia grows in the gap created by the incision, recovery time vary on the age, weight and occupation of the patient.  Recovery can vary between one to three months.  Complications include nerve entrapment and severe arch discomfort.  Heel spur removal.  Surgical removal of the bony growth is not successful in the majority of cases.  Removal of the attachment of the plantar fascia causes lowering of the longitudinal arch.  There are also reported cases of patients developing heel fractures post operatively.