Plantar Fasciitis Solutions: Brookings Health System, Brookings SD [Dr. Ryan Prusa]

I'm Ryan Prusa. I'm a Doctor of Podiatric Medicine, so a foot and ankle surgeon for Avera Medical Group. And we do our surgeries at Brookings Health System Hospital.

What are common type of heel pain?

Heel pain is something we see a lot in our practice, and it can really vary from, like, a plantar heel pain or a heel pain on the bottom of the foot all the way up to the back of the foot, kind of in the area of the Achilles tendon.

What is plantar fasciitis?

The most common type of heel pain that we see is a pain on the bottom of the heel. And that's most commonly associated with a condition called plantar fasciitis. The plantar fascia is a band of connective tissue that runs from the heel of the foot to the forefoot or the ball of the foot. And basically what happens in plantar fasciitis is there's an overloading or too much strain on that band of tissue. When that happens, it basically creates a pull on the heel. And that's where that inflammation and pain can come from.

What are the symptoms of plantar fasciitis?

So, there are some really telltale things that come with plantar fasciitis. One of those is after either sitting for a long time or first few steps out of bed in the morning. Really, that is when things are the most painful for people. Also walking on barefoot on hard surfaces. And then having pain after a long day of activity are really kind of the things that tell us that it's likely plantar fasciitis.

What are the risks for plantar fasciitis?

The number one thing is actually tight calf muscles, because it's all connected, like a pulley system. And when that calf is too tight, it puts overloaded strain on the bottom of the foot as well. Other things can be flatfoot, wearing shoes that don't have enough arch support, and then activity, or if you have a job where you're standing all day that can also overload the foot and cause issues.

When should someone contact their doctor about foot pain?

Yeah. So, really the kind of with plantar fasciitis, the sooner the better. The condition starts as an acute inflammation. And if we can get to it and treat it while it's still in that stage, evidence shows that we have a much higher chance of being able to successfully treat it with just some simple adjustments to activities and just some simple interventions. We wanna get to it before it becomes more of a chronic inflammatory or degenerative condition.

How is plantar fasciitis diagnosed?

On a first visit, we always start with just a really good physical exam. So, while we're doing that physical exam, we're looking for pain at a certain point on the foot. And that really can lead us down that plantar fascia route. We also eliminate other things that could be causing heel pain, because we never wanna miss, like, a fracture that we wanna rule out all those other options, so we make sure that we're treating the right condition.

What conservative treatments are available?

So, we start with some really simple conservative stuff that's really effective for most people. So, that's really good supportive shoes and inserts that provide support to the mid-foot or the arch of the foot. Stretching exercises to reduce strain that's coming from the Achilles tendon on the plantar fascia. We do some localized massage to the plantar fascia, icing, rest, reduced activity, while that inflammation is going down. And then we can also add some anti-inflammatory medications or steroids can help reduce some of that inflammation.

When is surgery considered?

Most people do get better with the simple conservative things. But there are also patients where that inflammation becomes more chronic and degenerative. Usually three to six months of those failed treatments and failed rounds of injections are when we start talking about surgical options. When we start talking about surgery is when the condition goes from an acute or just a short-term problem to more of a chronic issue. When that happens, the plantar fascia can become quite thickened, and there's a lot of scar tissue and degeneration happening in the plantar fascia.

How can surgery help patients with plantar fasciitis?

So, the surgery we do is called a plantar fasciotomy or plantar fascia release. So, essentially we just make a small incision in the area of the plantar fascia origin and actually cut the bands of plantar fascia that are tight and inflamed that are causing people pain. Essentially, it removes any force or strain that's on that inflamed area of the foot. We do only release part of the plantar fascia, so there is still a good portion of it left in the outside of the foot that can provide some of that strain relief.

What should patients expect during recovery?

After we perform the release, basically, we have the patient in a CAM boot. So, a protective boot, they can walk on it, we do recommend that they reduce activity and take it easy, so the inflammation and swelling don't become issues after surgery. With the surgery, the biggest thing is gonna be incision healing. At two weeks, we look at taking out the sutures, and then kind of transition back into normal shoe gear not too long after that.

So, after surgery, it is important for people to continue to wear good supportive orthotics and do the stretches and all those things that can reduce that mid-foot strain. Because with that plantar fascia gone, those forces do have to go somewhere. So, it's important to continue with those things that they were doing before the surgery.

How can surgery improve a patient's everyday life?

Yeah. So, really, the big thing is it's pain relief. This is the person they're dealing with this every day, it's every day when they get out of bed, they do not wanna step down on their foot, and they've been limiting their activities, changing things that they do every day because of their pain. So, really getting rid of that pain is it can be pretty dramatically changing for their lives, they get back to activity. And that is our ultimate goal is to get them back to that level of pain-free activity before their condition started.

What would you say to someone avoiding heel pain treatment?

It's important to get checked out early because we wanna rule out things that could be more serious and might need more aggressive treatment right away. The other aspect of that is that there's some very simple things that can be done that really result and good treatment without having to proceed to surgery if you can be seen early and implement those things while it's still an acute inflammatory condition as opposed to that thickening and scar tissue that we really would have to go in and do surgery for.