Heel pain, whether plantar fasciitis or plantar fasciosis, is a common foot problem that responds best to a step wise clinical protocol approach to treatment.
Plantar Fasciitis vs. Plantar Fasciosis
Plantar Fasciitis is heel pain that has been present for less than 6 months and is anacute inﬂammatory injury involving the plantar fascia (the ligament that holds up your arch and attaches to the heel bone). This responds well to anti-inﬂammatory treatments.Aggressive successful treatment of plantar fasciitis usually resolves heel pain in 6-8weeks.
Plantar Fasciosis is heel pain that has been present for more than 6 months and is characterized by a lack of inﬂammation and an exceptional amount of scar tissue and ﬁbrosis. The body's response to chronic inﬂammation is actually to give up and decrease the healing blood supply necessary for resolution. Successful treatment of plantar fasciosis requires irritation of the tissue, break up of the scar tissue and in fact are-injury of the area so that it transforms back to plantar fasciitis. Treatment of fasciosis needs to be aggressive and resolution can take up to 4-6 months.
Conservative Treatment: Step 1 (4-6 weeks)
- Steroid injections (no more than 3 in one year)
- Stretching exercises
- Shoe gear recommendations
- Prefabricated orthotics
- Night splint
- Relative rest
Conservative Treatment: Step 2 (next 6-12 weeks)
- Custom functional orthotics
- Rest (may require a walking cast)
- EPAT therapy (in-ofﬁce procedure)
- Physical Therapy (6-12 weeks)
Surgical Treatment: Step 3 (after 4-6 months of treatment)
- EPF (endoscopic plantar fascial release)
- Open plantar fascial release with heel spur resection
85% of patients get better with conservative treatment! Diligence and Consistency of treatment is the key!