Plantar Fasciitis Diagnosis & Treatment

Plantar fasciitis is well-known to many New Yorkers. Its symptoms, including pain that is centralized under the heel of your foot, make everyday tasks - such as walking to work or standing on the subway - difficult to complete comfortably.

Our goal as experienced podiatrists is to provide rapid relief for painful symptoms, improve your on-foot mobility, and provide a long-term solution to your plantar fasciitis.

Performance Footcare of New York Can Help Your Case of Plantar Fasciitis

Pain from plantar fasciitis can usually be remedied with conservative treatments, though more advanced cases will benefit from more direct treatments. During our consultation, we will inform you of what we feel is the most appropriate path to take.

Conservative Treatments

Rest - There is a common trend, especially among athletes, to return to normal duty (including sport) as soon as possible. This tends to cause symptoms from plantar fasciitis to flare up, and can also delay your recovery. Gentle walking and approved exercises (described below) are encouraged, but strenuous activity - including excessive standing - should be avoided until you have recovered.

Icing - Icing your foot (using an ice pack, bag of frozen peas, etc.) for 15-20 minutes at a time will help reduce inflammation and pain.

Over the counter painkillers and anti inflammatory medication - Painkillers may help with pain, as will anti-inflammatory medications. However, these medications address the symptom vs. the cause.

Cushioning and arch support - Providing a cushion for your feet is an effective way to reduce pain and allow the foot to heal. Wear supportive shoes that provide your foot with good heel and arch support; avoid sandals or worn footwear.

Exercises - Gentle stretching of the achilles tendon and plantar fascia can help ease symptoms and improve mobility. These exercises are outlined below.

Massage therapy - Done either at home, or by a trained professional. If you’re performing home care, give yourself a massage using a tennis ball. Put the tennis ball on the ground and gently rolling it under foot for a few minutes. This will help help loosen up your plantar fascia. The more pressure you put on the ball the deeper the massage, but like all things, don't overdo it when you feel pain.

Doctor-Facilitated Non-Surgical Treatments

Extracorporeal shockwave therapy - Using low-dose sound waves, the therapy incites an inflammatory response in the plantar fascia, creating a healing cascade that causes the body to address and resolve the problem. This treatment offers:
- Non-invasive healing
- No anesthesia, incisions, or other concerns associated with surgical treatment
- High success rate (comparable to surgery) with no post-treatment disability

Steroid injections - These injections rapidly address inflammation, reducing symptoms and alleviating discomfort. Paired with rest and other conservative treatments, steroid injections are a safe and effective way to hasten plantar fasciitis recovery.

Night splint - Wearing a night splint keeps the plantar fascia and achilles tendon slightly stretched.

Platelet-rich plasma injections - Using blood drawn from you body, platelets are separated from other cells using a centrifuge. The platelets are then mixed into a blood-solution and injected in the tendon, promoting healing and recovery. This procedure is most effective with chronic tendon injuries, such as Achilles Tendinitis.

Amnionic stem cell injections - Amnionic stem cell injectable is composed of micronised amnionic (placental) tissue. The specialized processing retains the amnionic growth factors and cystokines of these tissues. These growth factors and cytokines trigger inflammation reduction, scar tissue reduction, and an enhanced healing of micro-tears in soft tissue. These injections allow for a method to heal injured soft tissue areas after failed conservative treatments such as anti-inflammatories, physical therapy, and bracing without resorting to cortisone injections. At Performance Footcare of New York, amnionic stem cell injections are indicated for: plantar fasciitis, Achilles tendinitis, and other tendon/ligament injuries.

Surgical Treatments - Partial Plantar Fasciotomy

We are leaders in New York regarding minimally invasive surgical treatments for plantar fasciitis. However, we only advise surgery in cases where pain remains after 12 months (despite other treatments).

Surgery for plantar fasciitis (a partial plantar fasciotomy) is a fairly straightforward process:

A small incision is made above the heel pad (where the sole meets the back of the heel).
The plantar fascia is detached from the heel bone and, only if needed, the bone surface is smoothed (to allow the plantar fascia to heal with less tension). In some cases, we may remove a small chunk of the damaged tissue or work on the abductor hallucis to reduce the likelihood that nerves may become trapped or impinged.

Post-surgical recovery can take up to 3 months, with most people returning to normal activity within 3-6 weeks. Returning to intensive activities, such as running/jumping, may take up to 3 months post-surgery.

What is Plantar Fasciitis?

Plantar Fasciitis is the most common cause of foot pain and is the result of an inflammation of the plantar fascia- a band of tissue (like a ligament) that stretches from your heel to your middle-foot bones.

Plantar Fasciitis is relatively common, especially among New Yorkers who walk/run a lot.

Pain manifests in the heel. It may resonate directly under the heel or slightly in front of it. Pain may be experienced in one or both feet.

Symptoms

Pain in your foot (typically on the underside of your heel).

Pain that is worse in the morning or after long periods of rest (where the foot was not engaged or used)

Pain that worsens after activity (but not typically during)

Causes

Being overweight - this will put extra strain on your heel

Wearing shoes with poor cushioning or poor arch support

Spending a lot of time on your feet

Doing a lot of walking, running or standing

If you have recently started exercising on a different surface

Athletes who increase running intensity or distance

Plantar fasciitis is often caused by repeated stress on the heel as opposed to a singular larger incident.

How is Plantar Fasciitis Diagnosed?

Your doctor can usually diagnose plantar fasciitis just by talking to you and examining your feet. Rarely, tests are needed if the diagnosis is uncertain or to rule out other possible causes of heel pain. These can include X-rays of the heel or an ultrasound scan of the fascia. An ultrasound scan usually shows thickening and swelling of the fascia in plantar fasciitis.

Preventing Plantar Fasciitis

There are certain things that you can do to try to prevent plantar fasciitis, especially if you have had it before. These include:

Regularly changing training shoes used for running or walking.
Wearing shoes with good cushioning in the heels and good arch support.
Losing weight if you are overweight.
Regularly stretching the plantar fascia and Achilles tendon, especially before exercise.
Avoiding exercising on hard surfaces.

Exercises & Stretches That May Help Relieve Symptoms

Heel Stretch

Facing a wall, put your hands against the wall at about eye level. Keep the injured leg back, the uninjured leg forward, and the heel of your injured leg on the floor.

Both feet facing straight. Front knee bent, affected knee straight, rear heel locked against the ground. Slowly lean into the wall until you feel a stretch in the back of your calf.

Hold 3 times 30 seconds. Repeat 3 times on each leg.

Heel Calf Stretch

Stretching out the muscles in the lower leg is an integral step to recovery. There are two main muscles in the lower leg that attach to the heel, so we’ll work on stretching them both out.

Both feet facing straight. Front knee bent, affected knee straight, rear heel locked against the ground.

Hold this position for 30 seconds. Repeat 3 times on each leg.

Plantar Fasciitis Towel Stretch

Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around the ball of your foot and pull the towel toward your body keeping your knee straight.

Hold this position for 3 seconds then relax. Repeat 3 times. You should do this exercise 3 times per day.