Heel Pain Treatment
What is Endoscopic Plantar Fasciotomy?
Endoscopic Plantar Fasciotomy is a recent advance in foot surgery for the correction of Heel Spur Syndrome and Plantar Fasciitis. The technique allows for a quick recovery and a faster return to normal activity. The procedure is performed by utilizing specially designed instruments that allow the surgeon to directly visualize the foot structures on a video screen. It involves an outpatient surgical visit that takes approximately 20 minutes and only requires 2 small incisions.
What is Heel Spur Syndrome?
It is often described as a “stone bruise” by the patient. Pain is usually worse in the morning, especially the first several steps, or when first standing after periods of rest. As the pain worsens, the heel can hurt even while not weight-bearing.
What Causes It?
There is a dense fibrous band of tissue in the bottom of the foot known as the plantar fascia. The plantar fascia inserts into the heel bone and spreads out into the foot (see diagram). Studies have proven that the actual “spur” is formed over a long period of time because of constant pulling. The injury produces inflammation, pain, and inability to bear weight on the heel comfortably.
How is this procedure different?
In Endoscopic Plantar Fasciotomy, 2 small incisions are made to release the tight fascial band attached to the heel bone. This surgical release immediately eliminates the inflammation area of the “spur” and normal foot function can return. With the endoscopic procedure, it is not necessary to make a large incision. It is not necessary to remove the “spur” tissue in order to relieve the pain.
Am I a Candidate for this Procedure?
If you have failed to obtain complete relief of heel pain symptoms with the use of conservative treatments such as taping, orthotics, cortisone injections, oral medication or physical therapy, then you may benefit from an Endoscopic Plantar Fasciotomy. A complete evaluation and discussion with Dr. Dribbon will help determine your best options
What are the Expected Results?
Most patients return to their regular shoes in 3-5 days. Everyone heals slightly differently. Other factors such as age, weight, and occupation can contribute to healing times.
Heel Soreness Doesn’t Have to be a “Pain in the Foot”
By Steven Dribbon, D.P.M.
The article as seen in The Home News Tribune
Chronic heel pain often begins with a bit of stiffness when you climb out of bed in the morning or when you begin walking after sitting for a long period, such as when watching TV or reading. If gone unchecked, it can become a nagging pain that may result in the need for surgery.
Often described as a “stone bruise,” the painful condition known as plantar fasciitis first presents itself as soreness on the bottom of the heel. Plantar fasciitis is an “overuse” injury and for many people does not necessarily hurt during exercise when they may be warmed up, but more likely does so once they stop.
Surprisingly, those individuals with jobs requiring them to spend a great deal of time on their feet are not necessarily as highly prone to the condition as you might think. Baby boomer-types, weekend warriors, women and people who are overweight are slightly more likely to develop the condition. People with high arches, flat feet, excessive “pronation” and/or poorly fitting shoes are also more likely to develop heel pain like plantar fasciitis.
What causes it?
There is a dense, fibrous band of tissue at the bottom of the foot known as plantar fascia. It can be likened to a stalk of celery in both the way it is shaped (wider at one end), its consistency and makeup, and its tapered appearance. The plantar fascia inserts into the heel bone and spreads out along the bottom of the foot, getting wider toward the toes. As one ages and the plantar fascia loses any elasticity it had, it can develop minute tears and become inflamed. The constant pulling and pressure also can cause “heel spurs” to develop – although a heel spur need not be present for pain to exist.
When the pain becomes too much, individuals often seek medical attention. This is generally a sensible move because, if left untreated, plantar fasciitis can become chronic.
The first course of treatment is usually the use of an over-the-counter pain medication, such as non-steroidal anti-inflammatory drugs like ibuprofen, coupled with ice and rest. A home exercise program is usually developed in an attempt to stretch the plantar fascia and prevent recurrence. (The plantar fascia is neither a muscle nor a tendon; it is a separation layer of tissue attached along its length to a person’s foot.)
Doctors also treat plantar fasciitis with orthotics such as shoe inserts for arch support, use taping techniques and even use splints to allow the aggravated area to rest. Physical therapy and sports massage are sometimes used. Doctors also may inject the heel with anti-inflammatory corticosteroids in an attempt to relieve pain.
If a patient has failed to obtain complete relief of heel pain symptoms with the use of conservative treatments such as taping, orthotics, cortisone injections, oral medications and physical therapy, he or she may benefit from a surgical procedure known as an endoscopic plantar fasciotomy. After a full consultation with a doctor, this procedure is performed using an endoscope, which includes a tiny camera, and specially designed instruments a surgeon uses while viewing the structures of the foot on a video monitor.
In endoscopic plantar fasciotomy, the surgeon makes two small incisions to release the tight fascial band attached to the heel bone. This immediately eliminates the inflammation of the plantar fascia, and normal foot function can return. Because an endoscope is used, it is not necessary to make a large incision, and it is not necessary to remove the spur tissue in order to relieve the pain.
The procedure can be done using local anesthesia and generally takes about 15 minutes. Most patients are able to wear sneakers or soft shoes in three to five days and feel 80 to 90 percent improvement in three weeks. Athletes are able to return to competitive sports such as tennis or racquetball in about a month.
One of the biggest benefits of endoscopic plantar fasciotomy is that there is almost immediate relief of the condition, and people return to regular activities quickly rather than spending a lot of time on various other treatments. As a result, they spend less time off their feet, less time in surgical shoes and less time in after-care and disability compared to other procedures. Many patients prefer the month-long surgical recovery over a series of non-surgical steps that could take anywhere from six to 18 months before complete resolution of a patient’s symptoms.
The small incisions (about one-quarter inch) in endoscopic plantar fasciotomy heal faster and result in less pain, returning a person to his or her regular activities quite rapidly and without pain. Infections are infrequent and the procedure is covered by most insurance plans.
After all conservative approaches are exhausted, endoscopic plantar fasciotomy often is the treatment of choice for many people and results in an exceptionally low incidence of people ever returning to their doctor with heel pain.
Michael Molitoris, DPMPodiatrist
John V. Kramer, DPMPodiatrist
Steven M. Dribbon, DPMPodiatrist
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