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Question
Posted by: Adri | 2006/04/18

Plantar fasciitis

What does an operation iro this entails - is it effective?

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Our expert says:
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Hallo Adri
Plantar fasciitis is one of the most difficult things to treat - I really can't promise you that it will be effective. Personally I would first try all the non-invasive options before operating.
NSAIDs and ice have been used for symptomatic treatment of plantar fasciitis, although no studies have been done to determine efficacy.
Corticosteroid injections have been shown to improve symptoms at 1 month but not at 6 months. These injections have been shown to be associated with plantar fascia rupture and fat pad atrophy. These injections should be used conservatively and should probably be left to podiatrists for use, as NSAIDs would be proper first-line management in the ED.
Extracorporeal shock-wave therapy (ESWT) has been used to treat plantar fasciitis. Although its efficacy is not definitively proven, it has been approved by the Food and Drug Administration for the treatment of plantar fasciitis and tennis elbow. The therapy bombards the tissue with high-pressure sound waves with its mechanism of action being to (1) stimulate blood flow for a beneficial immune response, (2) reinjure tissue to stimulate healing, and (3) shut down the neuronal pain pathways through the pulses hitting the affected nerves.
Surgery for plantar release (open and endoscopic) has been used in extreme cases that are unresponsive to conservative treatments.
Deterrence/Prevention:
The patient should decrease weightbearing activities (especially running), if possible.
Shoes inserts (both custom-made orthotics and prefabricated insoles) have been used in conjunction with stretching. No definitive evidence exists that one type of insole is better than another.
Night splints made to hold the ankle in dorsiflexion and the toe in extension have been used. One Cochrane review found limited evidence in the use of night splints in patients with pain lasting 6 months.
Stretching is commonly used, but the exact benefits are unknown. One randomized control trial showed that there was greater improvement in pain with plantar fascia stretching as opposed to Achilles tendon stretching.
Casts or splints holding the ankle in neutral to slight dorsiflexion have been investigated, although efficacy is controversial.

Prognosis:
Eighty percent of cases resolve spontaneously by 12 months. Five percent of patients end up undergoing surgery for plantar fascia release because all conservative measures have failed.



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