Chronic plantar Fasciitis, Is Surgery Only Option?

by Candy
(Houston, Texas)

Heel pain when walking, arch pain with frequent muscle spasms. Pain present while exercising but tolerable. (Group exercise instructor with 14 classes p/ week) Can't walk in morning or evening. Have done PT for several months. Ice 3 x daily, 4 cortisone injections, PRP injection (was not effective), wore boot for 2 months. Allowed me to walk however causes arch to collapse due to no support. (I have high arch). Dr is recommending surgery. Is this only other option?

RESPONSE

Hi Candy,

Well it does sound like you are running out of options. I am wondering if all these treatments have been on the recommendation of only one doctor, or have you been to multiple doctors all of whom have tried something different to no avail.

The reason I am asking is because even though it sounds like you have plantar fasciitis, there is always the possibility that you have more than just plantar fasciitis. I say this because plantar fasciitis pain is typical when you first get up on the foot and there is heel pain. In most cases this is because the ligament has tightened up and initial standing stretches the tight ligament and there is pain; it will start to subside somewhat as you walk.

However, if you have pain the "more" you are on your foot then that may or may not be plantar fasciitis. The more you are on your foot, the more pounding there is on the heel and there is a chance that pain could be from another source such as a heel bursitis or a heel neuroma which are two conditions also seen in heel pain.

Along the lines of other problems that can cause heel pain, has any doctor ruled out tarsal tunnel syndrome?

Additionally, I would assume at this point you have at least had an MRI. An MRI would show potential heel pain problems such as a partially torn plantar fascial ligament as well as a possible stress fracture of the calcaneus which is your heel bone. Of course, there is also the very remote chance that you could have an abnormal growth of some sort in the calcaneus and that needs to be ruled out as well.

As you can see there is the possibility that you could have surgery, have the plantar fascial ligament released and still have pain afterwards because there are other issues going on in your foot.

The reason I asked you if you have seen more than one doctor is because sometimes physicians have "tunnel vision" and they see heel pain and all they know is plantar fasciitis whereas if you have been to multiple doctors, particularly those who specialize in the foot, I would assume that someone would have ruled out more than just plantar fasciitis.

As a side note, walking in a boot with no support for your high arched foot could actually make the problem worse or at the very least been a waste of two months. This also begs the question of whether or not you were given orthotics as a treatment option? For plantar fasciitis, orthotics are the central point of my treatment regimen. Without supporting the plantar fascial ligament while you walk and exercise, the ligament continually over stretches and thus never has a chance to heal in spite of all the other treatments. By eliminating the over stretching with an orthotic, the other treatments become much more effective.

The general consensus is surgery would be the next option since you have tried every thing (but an orthotic) and assuming the other potential heel problems have been ruled out. This is an elective procedure and as such there are inherent risks involved (hopefully your doctor will explain them to you). But, the so called risk-reward ratio is in your favor because you have tried most of the conservative treatments and they have proved futile.

In closing, do not be afraid to ask your doctor about the possible conditions I have mentioned and if you have any doubts, go get yourself a second opinion.

Marc Mitnick DPM
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