The study found that botox was more effective than cortisone for pain relief and recovery and that it did not have the same (rare) side effects as cortisone which include rupture of the plantar fascia and the loss of fat pad (though this likely only happens in cases where the same area has been repeatedly injected).  The study did also stress the importance of stretching as prescribed by your physiotherapist in conjunction with the injection. So if you are suffering from plantar fasciitis, please contact our office and have one of our experienced physiotherapists assist you in your timely recovery!
Plantar fasciitis is most often seen in middle-aged men and women, but can be found in all age groups. Plantar fasciitis occurs because of irritation to the thick ligamentous connective tissue that runs from the heel bone to the ball of the foot. When a patient has plantar fasciitis, the connective tissue that forms the arch of the foot becomes inflamed (tendonitis) and degenerative (tendinosis)–these abnormalities cause plantar fasciitis and can make normal activities quite painful.
To prevent the recurrence of plantar fasciitis after treatment, proper fitting footwear is essential.
As stated above, simple treatment measures will usually work in the treatment of plantar fasciitis.
Surgery should be reserved for patients who have made every effort to fully participate in conservative treatments, but continue to have pain from plantar fasciitis. If you fit these criteria, then surgery may be an option in the treatment of your plantar fasciitis. When your surgeon releases the plantar fascia, it is important to only release about 30-50% of the fascia. As stated earlier in this article, pain around the heel of the foot may not always be due to plantar fasciitis. Symptoms of plantar fasciitis may closely resemble symptoms of other foot problems. New surgical techniques allow surgery to release the plantar fascia to be performed through small incisions using a tiny camera to locate and cut the plantar fascia. Plantar fasciitis is the most common cause of heel pain, accounting for 11 to 15% of all foot symptoms that needed medical treatment each year. Baxter’s neuropathy is entrapment of a local nerve under the heel by the plantar fascia. You’ve probably come to the realization that a lot more goes into the diagnosis and treatment of plantar fasciosis than you once thought.

Plantar fasciitis is diagnosed with the classic symptoms of pain well localized over the heel area of the bottom of the foot. This treatment, called extracorporeal shock wave therapy, or ESWT, uses energy pulses to induce microtrauma to the tissue of the plantar fascia. The vast majority of patients diagnosed with plantar fasciitis will recover given ample time.
Release of more of the plantar fascia during surgery may cause a flat foot deformity due to the loss of the arch of the foot. These nerves, even with protection, may be damaged during surgery to release of the plantar fascia. A 2013 study in the medical journal, Skeletal Radiology, found degenerative changes via diagnostic ultrasound in the plantar fascia at various areas of the foot including the insertion (heel) and non insertional sites (other attachment points on the foot). The application here is that multiple different paths all lead to the same end result of plantar fasciosis. About 70% of patients with plantar fasciitis have been noted to have a heel spur that can be seen on X-Ray. Often the pain from plantar fasciitis is most severe when you first stand on your feet in the morning. These syndromes such as Reiter’s syndrome and ankylosing spondylitis can cause heel pain similar to plantar fasciitis.
Time is very important in curing the pain of plantar fasciitis, and insufficient treatment before surgery may subject you to potential complications of the procedure.
With some basic treatment steps, well over 90% of patients will achieve full recovery from symptoms of plantar fasciitis within one year of the onset of treatment. Flat foot after surgery can lead to chronic problems that may be as bad as the plantar fasciitis. Because of this, a small percentage of patients may have pain or numbness in areas of the foot following plantar fasciitis surgery. While there are potential complications, about 70-80% of patients will find relief after plantar fascia release surgery.

Some surgeons are concerned that the endoscopic plantar fascia release procedure increases the risk of damage to the small nerves of the foot. For example, a recent post we found had recommendations for ice, Motrin, and stretching for a woman in her mid 30’s with a 4-5 month history of bilateral (both sided) plantar fasciosis that had not seen a medical or allied health provider. If your symptoms are not typical for plantar fasciitis, or if your symptoms do not resolve with treatment, your doctor will consider these possible diagnoses.
If these treatments fail, your doctor may consider an operation to loosen the plantar fascia, called a plantar fascia release.Because the diagnosis of plantar fasciitis can be confused with tarsal tunnel syndrome (as described earlier), most surgeons advocate performing a tarsal tunnel release (or at least a partial tarsal tunnel release) along with the plantar fascia release. This may not be perfect, but if plantar fasciitis has been slowing you down for a year or more, it may well be worth these potential risks of surgery.
While there is no definitive answer that this endoscopic plantar fascia release is better or worse than a traditional plantar fascia release, most surgeons still prefer the traditional approach. Heel spurs tend to hurt at the end of the day as opposed to plantar fasciosis which hurts after periods of rest including first thing in the morning.
These simple exercises will help maintain the flexibility of the foot and prevent the plantar fasciitis pain from returning. The posterior tibial nerve can be stretched, compressed or entrapped leading to referred pain in the heel that is not due to plantar fasciosis. Plantar fasciosis and stress fractures have the location of pain as similar, but stress fractures differ in the the intensity of pain combined with the reports of worse with increased activity and hard surfaces. Biopsies performed at the time of surgery combined with diagnostic ultrasound studies show long standing degenerative changes to the tissues of the plantar fascia WITHOUT INFLAMMATION. Maybe, the treatment should focus on the pathway to get to plantar fasciosis rather than treating the plantar fasciosis itself.
Plantar fasciosis is described as dull, aching pain at rest that turns to sharp and stabbing pain when transitioning up and walking the first couple steps.

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