Heel Spur Surgery (Plantar Fasciitis)

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The Condition Defined & Detailed Out

The Basic Anatomy

Talking of the foot the fascia found here is known as plantar fascia, a thickened band of ligament found at the bottom surface of the foot. It originates at the heel bone and runs all along the longitudinal axis of the foot and up to the “ball of the foot”.

The Function

Normally, the plantar fascia is elastic in nature and provides support to the foot-arch and foot bones. This tough band is responsible for maintaining stability of the entire foot and thus, helps in propping up the entire body weight. It also serves to tighten and keep taut the longitudinal foot to toe while walking or running.

The Anomaly

The inflammation of the band of tissue, the plantar fascia that extends from the heel to the toes, is known as plantar fasciitis. The fascia is similar to a ligament in certain features, like it can tear, thicken, be injured by direct trauma or by constant strain over time, and become painful.

In plantar fasciitis, the fascia first becomes irritated and then inflamed, resulting in heel pain. Heel spurs may also form from the pulling of the plantar fascia on the bone but the source of the pain is typically the fascia itself and not the spur. The spur would not be usually a source of pain and rarely requires removal.

The Causes Of Plantar Fasciitis

  • Faulty Structure Of The Foot such as arches that are either overly flat or high, causing flatfeet and high-arched feet, respectively
  • Wearing Ill-Fitting, Unsupportive Footwear on hard, flat surfaces exerting abnormal stress on the plantar fascia, leading to plantar fasciitis.
  • Staying On Feet for extended durations of time vis-à-vis job requirement
  • Obesity causing the fascia to be over-stressed and undergo rapid wear and tear
  • Overuse & Repetitive Usage also highly contributing to plantar fasciitis
  • Exercising via walking or running with stiff, tight calf muscles
  • Reduced Length of calf and hamstring muscle leading to the fasciitis
  • Restricted Ankle Joint Movement acting as a probability of causing the foot condition
  • Reactive Arthritis & Ankylosing Spondylitis as probable disease agents giving rise to plantar fasciitis

The Signs & Indications Of Plantar Fasciitis

  • Pain & Tenderness at the bottom of the foot
  • Tenderness affecting the entire sole of the foot, especially the heel region
  • Appearance Of Heel Spur as a bony prominence developing at the site where the fascia attaches to the calcaneus (heel bone)
  • Difficult & Painful walking and running activities
  • Barefoot Walking turned difficult on hard, solid surfaces
  • Sole Of The Foot feeling warm and swollen to touch
  • Arch Of The Foot under painful and discomforting situation
  • Worsening Pain usually upon arising
  • Gradation In Pain that occurs over a period of several months

The Diagnostics Of Plantar Fasciitis

Plantar fasciitis is diagnosed completely by your podiatric specialist based on the findings through the following tests and procedures:

  • A Thorough Medical History for careful decision-making
  • A Detailed Physical Examination for general assessment and ruling out other foot conditions
  • Imaging Techniques that include:
    • X-rays
    • Ultrasound Scans
    • MRI Scans

Note: The latter two imaging techniques are rarely employed as diagnostic tools for plantar fasciitis.

The Treatment Modalities Of Plantar Fasciitis

The aim of your orthopedic physician is to get your plantar fasciitis treated by such measures that decrease the associated inflammation and pain, and avoid re-injury to the all-important fibrous structure in the base of the foot. Your New York podiatrist typically advises conservative treatment as the preferred option, but surgical intervention needs to be considered and decided on if your pain does not subside or resolve after 6 months of noninvasive therapy.

The Conservative Treatment Methodology

The vast majority of plantar fasciitis cases (nearly 90%) are treated conservatively employing a combination of therapies to treat the symptoms that include:

  • Rest, Ice, Compression & Elevation (RICE) therapy happens to be the basic home-based remedy.
    • Give ample rest your foot as your foot condition heals up naturally.
    • Ice has to be applied wrapped up in a towel and placed onto the swollen area for around 20 minutes, several times a day.
    • Applying compression to the painful foot would lessen the inflammation and discomfort
    • The affected foot has to be kept elevated while raising it above your chest level during sleep.
  • Insoles/Heel Pads act as shock absorbing materials to reduce the sharp, stinging pain when walking, and helping in improving your symptoms.
  • Taping, Padding Or Strapping your foot to maintain the arch can help by taking significant pressure off the plantar fascia.
  • Custom Orthotic Devices are an effective means of providing added support to the arch by wearing them all day.
  • Night Splints can keep the affected foot stretched and the ankle at right angles during sleep, so that the symptoms can be minimized.
  • Limit Routine Activities by slashing extended physical activities to give your heel a rest to heal well.
  • Removable Walking Cast may be used to keep your operated foot immobile for a few weeks to allow it to rest and heal properly.
  • Medication is usually recommended if the pain is recent, in the form of painkillers and anti-inflammatory drugs to keep the pain and swelling at bay.
  • Steroid Injections are offered in case other therapies don’t suffice or fail altogether. However, these pose a minor risk of infection, increased pain in the region and damage to heel-pad tissues.
  • Physiotherapy is usually advised as a program of specific stretches and exercises which can dramatically improve the symptoms by reducing inflammation and strengthening the foot muscles to support the weakened plantar fascia.
  • Exercise & Workout by stretching your calves and the plantar fascia is the ideal way of relieving pain arising out of tightened and stiffened muscles in both the structures.
  • Controlling Obesity is essential in lessening the undue stress on your feet.
  • Extracorporeal Shockwave Therapy proves to be handy and effective in cases where the other therapies have given in to improve the symptoms, by stimulating the healing process.

The Invasive Treatment Methodology

Surgical procedure is considered only after 12 months of aggressive and continuous nonsurgical treatment has failed in producing the desired outcome. Your foot and ankle surgeon would carry out discussion with you on the surgical options available and determine the most beneficial approach for you. Although the success is comparatively poor than other podiatric surgeries, hovering around the 60% mark, invasive treatment is sought as the terminal means of bettering the painful, debilitating condition.

The surgical process comprises of the following procedures, performed either singly or in conjunction with each other:

  • Gastrocnemius Recession is a surgical lengthening of the calf (gastrocnemius) muscles. This procedure is useful for patients who still face difficulty flexing their feet, despite spending a year in calf stretches, since tight calf muscles place increased stress on the plantar fascia.

In the recession procedure, one of the two calf muscles is lengthened to increase the range of motion of the ankle. The operation can be performed with a traditional, open incision or with a smaller incision and an endoscope (an instrument containing a small camera) introduced. Complication rates for gastrocnemius recession are low, but may be severe resulting in nerve damage.

  • Plantar Fascia Releaseis usually recommended by your foot expert if you have a normal range of ankle motion and persistent heel pain.

During surgery, the plantar fascia ligament is partially cut to relieve tension in the tissue. If a large bone spur is present, it would be removed along with the fascia release process. Although the surgery can be performed endoscopically within lesser duration, it is more difficult than with an open incision. Additionally, endoscopy poses a higher risk of nerve damage making it a disagreeable option. The most common of complications of this surgery includes inadequate and incomplete pain relief and nerve damage.

The Associated Complications

  • Bacterial Infection In The Wound
  • Damage To Nerves & Blood Vessels
  • Persistent Pain In The Heel
  • Form & Function Of the Foot Suffering Due To Extra Fascia Tension Relief