When Heel Pain Won't Quit!

Most patients with plantar fasciitis respond well to our usual treatment protocols. In some instances symptoms persist despite treatments. In these cases, it is thought that the healing process of the plantar fascia injury stops prematurely leaving the area in a partially healed state. The term we use for this is plantar fasciosis. Treatment at this stage requires restarting the healing process. There are several treatments that we can use for this. Prolotherapy. This treatment uses a series of injections of dextrose solution into the injured area of the plantar fascia 1-2 weeks apart. Injection or dextrose solution cases a small amount of trauma to the area to trick the body into restarting the healing process. The advantage of this technique is that it is inexpensive and readily available in the office. The main disadvantage is that it does require multiple treatments, typically 3-5, to achieve the desired results. Growth Factors. Growth factors are chemical substances produced by the body to control the growth and healing of tissues. There are several ways in which growth factors can be used for musculoskeletal problems. The most commonly used are amniotic fluid, platelet rich plasma, and bone marrow aspirate. These substances are injected into the area of injury to restart and help guide the healing process. Amniotic fluid is donated from pregnant women and is processed to be used for therapy. Platelet rich plasma is acquired from the patient by drawing blood and processing it for injection. Bone marrow aspirate is acquired using a small surgical procedure to remove a small amount of bone marrow from the heel bone which is processed for injection. The advantage of these treatments is that they usually require a single treatment. The main disadvantage is the cost, which is not covered by insurance. Acquisition of these products cost between $500.00 and $900.00Extracorporeal Shockwave Therapy. This technique employs a machine similar to the ones used to break up kidney stones. The device uses high energy ultrasound waves delivered to the injured area to cause a small amount of trauma to again trick the body into healing the injury. This non invasive treatment can be performed in the office setting with the use of local anesthetic. 1 treatment session is usually sufficient but a second treatment can be performed after 6 months if there is incomplete relief of symptoms. This is a very effective treatment with good support in the medical literature. The main downside is the cost as this technique is not always covered by health insurance. If not covered the cost is $2800. Surgical options Surgery for chronic plantar fasciitis most often entails release of the plantar fascia, termed plantar fasciotomy. The minimally invasive endoscopic plantar fasciotomy is the preferred technique for release of the plantar fascia. This procedure is performed in the outpatient setting using specialized equipment through small incisions on the side of the heel. This approach allows for immediate weight bearing after surgery with return to sneakers within 1 week. Return to full activity is usually in 4-6 weeks. Surgical procedures are often covered by health insurance. For those patients that don’t want the hassle or potential additional costs associated with hospital surgery an office based procedure can be performed. The instep partial plantar fasciotomy uses a small incision on the bottom of the foot just forward of the heel pad to get to the medial band of the plantar fascia for release. This technique does require a period of non weight bearing for 2 weeks to allow the incision to heal. This is followed by protected weight bearing for and additional 4 weeks. Don’t get discouraged with heel pain that won’t quit. We have a lot of options available to get you back to action!

Paul Betschart, DPM Dr. Betschart has over 26 years of experience in treating patients of all ages with all kinds of foot and ankle conditions. His mission is to provide you with helpful information about foot and ankle issues and the latest developments in healthcare.

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