The plantar fascia (PF) is a thick band of tissue that connects your heel bone to your toes. It helps support the overall shape of your foot, especially when standing, and helps with shock absorption. Irritation and scarring of the plantar fascia, known as plantar fasciitis, is one of the most common causes of heel pain. Plantar fasciitis can result from calf/Achilles tendon stiffness, overactivity, improper shoes, flat feet, or excessive weight on the feet.
The standard treatment for plantar fasciitis starts with decreasing inflammation in order to decrease pain. Initial methods include daily stretching (of the calf, Achilles tendon, and/or plantar fascia) and wearing a splint on the foot at night. Some patients may not be able to wear the night splint, but the idea is to keep calf and plantar fascia stretched. Your foot and ankle orthopaedic surgeon may also recommend anti-inflammatory medications or changing shoes. If these treatments do not help, the next step is often steroid injections into the PF.
Patients who have heel pain due to plantar fasciitis may benefit from a plantar fascia injection. The injection should not be considered until non-surgical treatments have been tried and failed to relieve the pain. You should not have an injection at the PF if you have an allergy to the medicines being used or skin problems at the heel. Multiple repeated injections can risk rupture to the PF.
Your foot and ankle orthopaedic surgeon will inject the PF where it is most painful. The injection can be made of steroids, numbing medicines, or a combination of both.
Most doctors inject the PF from the inner (medial) side of the heel, instead of directly underneath. This helps to avoid pain and injury at the heel's fat pad. With the patient lying down, the heel is marked where it will be injected. Your surgeon will use a thin needle to inject the medicine into your foot. After the injection, your surgeon will cover the site.
The numbing effect usually lasts a few hours after the injection. When this numbness wears off, your heel pain may return temporarily. The steroid will relieve heel pain over the next several days, and it may continue to work for several weeks to months. It is unknown exactly how long the injections can last.
You will be encouraged to restart exercises when it's comfortable. Most doctors recommend that patients resume foot, calf, and Achilles tendon stretching. Hard activities should be avoided for the first few days after the injection. A removable walking boot may be used for a short period of time to decrease pain and inflammation.
Risks include thinning of the fat pad and bleaching of the skin at the plantar heel. Tearing or rupture of the PF also can occur.
Steroid injections do not cure plantar fasciitis, but they can relieve pain for 3-6 months.
Minimally invasive treatment options such as shock wave therapy have been shown to be potentially helpful for plantar fasciitis. If all of these options fail, the definitive treatment is a plantar fascia release, which involves cutting the plantar fascia. Talk to your foot and ankle orthopaedic surgeon about your options.
Original article by Eric Lloyd, MD
Contributors/Reviewers: Jamal Ahmad, MD; Andrew Pao, MD
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