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Plantar Fasciitis: diagnosis and suitable treatment options

Plantar fasciitis is the most common cause of walking pain at the point where the plantar fascia attaches to the heel bone on its inner portion, often associated with the presence of a small bony protrusion called a heel spur.

The age at which this inflammation occurs is typically between 40 and 60 years and affects both males and females equally.

Factors contributing to its onset are attributed to certain lifestyles such as:

  • Prolonged standing
  • Overweight/obesity
  • Type of physical activity (running, jumping, soccer)
  • Wearing inadequate shoes
  • Presence of tight calf muscles.

Which are symtomps and the correct diagnosis?

The main symptom of plantar fasciitis is pain, often more severe upon waking when taking the first steps, localized primarily on the inside of the heel, frequently radiating along the entire plantar fascia to the toes.

In most cases, the pain develops gradually, felt after periods of inactivity. Additionally, it can be unilateral, affecting only one foot, or bilateral, involving both feet.

In the initial phase of pain, it tends to decrease throughout the day before reappearing towards the evening. In cases of a chronic clinical condition, the pain persists throughout the day, especially in the presence of a heel spur.

The most suitable examination to identify a problem like a heel spur is a lateral foot X-ray or, alternatively, ultrasound examination and MRI. Before that, it is advisable to conduct a medical history, including details of the symptoms, medical history, occupation, as well as habits.

The possibile treatments: conservative or surgical?

It has been demonstrated that conservative therapy is more effective in the early stages of the disease (before the spur has formed). This consists of:

  • Rest from activities that exacerbate the pain (running, long walks).
  • Administration of systemic pain-relieving medications.
  • Administration of local pain-relieving medications (infiltrative therapy).
  • Use of suitable shoes with orthotic insoles (silicone insoles).
  • Targeted action to reduce risk factors (e.g., a low-calorie diet for weight loss).

When conservative therapy fails to alleviate the symptoms due to the presence of a heel spur with recurrent pain and continuous irritation of the surrounding soft tissues, surgical removal of the spur with plantar fascia release becomes necessary. Through a microsurgical technique under local or regional anesthesia, a mini skin incision of about 3 mm is made at the level of the heel. Subsequently, under radiographic control, the heel spur is removed using a micro drill.

Thanks to this technique, recovery times are extremely rapid, and the foot can be weight-bearing just after a few days. After approximately one week, normal physical work activities can be resumed using a special heel cushion.

Doc. Leonardo Donati and the mini-invasive surgery at MiniHospital “Sandro Pertini”

In order to address issues such as plantar fasciitis, the MiniHospital “Sandro Pertini” relies on expert specialists in the field of surgery. Among them stands out Dr. Leonardo Donati, a medical specialist in Orthopedics and Traumatology who, for 10 years, has been involved in the microsurgical treatment of the most common foot pathologies, with thousands of surgeries performed.

Microsurgery of the foot, or percutaneous surgery, follows the philosophy of minimizing surgical trauma by using microsurgical access points (incisions of about 2 mm) and micro-drills to shape the bone in order to promote a rapid functional recovery free from postoperative pain.

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