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Posts for tag: bottom of foot pain Chattanooga

    Heel pain, especially Plantar Fasciitis, is one of the most common problems seen in the foot and ankle specialist's practice.  This condition is very easy to treat, but often not very easy to cure.  There are many conservative treatment options for this condition, and as with many other foot and ankle problems, surgery is also an option.  Surgery for this condition, however, should always be the LAST option, and only considered when conservative measures have failed to give significant relief of pain.  Why do I say this?  First of all, there is no treatment for plantar fasciitis or pain on the bottom of the heel that is over 80 or 85% effective in curing this problem.  Surgery is only effective in about 70% of cases of plantar fasciitis.  Some studies report an even lower success rate in the 50 to 60% range.  There are SO many conservative treatment options, some of which we will explore below, that surgery should be the DOCTOR'S AND THE PATIENT'S LAST OPTION!  

    Conservative treatments for plantar fasciitis include the following:  exercises, steroid (cortisone) injections, NSAIDS (oral anti-inflammatory drugs), night splints, custom orthotic devices, over the counter supports and insoles, physical therapy, shockwave treatment, laser therapy, PRP (injections of platelet rich plasma), walking boots, stem cell injections, and there are surely others that I just can't think of right now.  Oh, but some of these are "unacceptable" to patients - or in some cases, the doctor - because (1) it takes too much time  (2) it alters the type of shoes worn ...and of course.....(3) it may not be covered under insurance, many cases, the patient, and sometimes the doctor, chooses SURGERY.  After all, you get it done in one visit and "it's (usually) covered under insurance."  But the downside with the surgery is a lot bigger than the downside with any of these conservative treatments.  With any of these treatments, there is always a chance it may not work.  With surgery, not only is there about a 30 to 40% chance it won't work...but may get an infection, or a slow healing wound, or long term swelling,  you may get a flatter or more unstable foot, or  nerve injury/entrapment, or problems with the anesthetic (if you are given general anesthesia), or you may have a different problem or pain after the surgery that you did not have before the surgery.   One procedure, which was quite popular in the 1990's was the Endoscopic Plantar Fasciotomy.  A very small incision was made on each side of the heel, and a small scope was inserted in one side, cutting the ligament from the other side.  In some ways, it was a very effective procedure, in other ways it was risky.  I did the procedure in selected cases, and still do from time to time, but it is NOT without potential problems.  For a few years. this procedure was done so quickly by so many foot surgeons, where conservative treatment was not even tried, that it caused one very prominent Chicago foot and ankle surgeon to refer to it as "the rape of the plantar fascia."  

     Am I saying that surgery should NEVER be done for plantar fasciitis?  NO.  There are cases where it is necessary, especially if a person has had constant  severe heel pain for 9 to 12 months and has had multiple attempts at conservative treatment with little or no improvement.  My point is to be patient - don't consider surgery because one or two things that have been tried did not work - and most of all, don't let your insurance company decide how you are treated.  Be prepared that many of the most effective non-surgical treatments take time and are not covered under insurance.  Surgery should be the LAST resort for this problem. 


Richard S. Eby, DPM

7348 East Brainerd Road

Chattanooga, TN.  37421