eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Plantar Heel Pain: Follow-up

Author: Vinod K Panchbhavi, MD, FRCS, FACS, Associate Professor, Chief, Division of Foot and Ankle Surgery, Department of Orthopedics, University of Texas Medical Branch School of Medicine
Contributor Information and Disclosures

Updated: Jun 17, 2008

Follow-up

Deterrence/Prevention

  • Because overuse is the most common cause of plantar fasciitis in athletes, avoiding overuse can help prevent this problem.21

Complications

  • Of patients with plantar fasciitis, 90% respond favorably to conservative care. Conservative methods should be tried for at least 6 months (preferably 12 mo) before surgery is considered. Furthermore, patients should be fully counseled regarding the risks and benefits, because complete satisfaction after surgery is observed in only 50% of patients.
  • For nonsurgical treatment, depot steroid injections can provide good short-term relief of symptoms; however, multiple injections can cause the plantar fascia to rupture and the fat pad to atrophy, especially if the injection is not administered deep into the fascia.22,23,24
  • Regardless of whether an open or endoscopic method is used for surgical correction, only 50% of the plantar fascia should be released, because a complete release can lead to collapse of the medial and lateral longitudinal arches.
  • Endoscopic plantar fascia release can be associated with a higher incidence of nerve damage and painful and hypersensitive neuroma.25,26

Prognosis

  • Proximal plantar fasciitis is successfully managed with conservative care in approximately 90% of cases. In general, the longer the duration of symptoms, the longer it takes for the patient to obtain complete pain relief.

Miscellaneous

Medicolegal Pitfalls

  • Surgical treatment for heel pain should only be considered after thorough counseling regarding the risks and benefits. Endoscopic plantar fascia release can be associated with a higher incidence of nerve damage and painful and hypersensitive neuroma.
  • A complete division of the plantar fascia is no longer recommended. Inadvertent complete division of the plantar fascia can lead to lateral column syndrome, which is pain in the calcaneocuboid region and lateral aspect of the hindfoot.
  • Heel pain in elderly patients or patients with atypical presentations should be investigated for deficiency fractures or for tumors (see Image 9).
 


More on Plantar Heel Pain

Overview: Plantar Heel Pain
Differential Diagnoses & Workup: Plantar Heel Pain
Treatment & Medication: Plantar Heel Pain
Follow-up: Plantar Heel Pain
Multimedia: Plantar Heel Pain
References
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References

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Further Reading

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Keywords

heel pain syndrome, plantar fasciitis, proximal plantar fasciitis, heel spur, plantar heel pain, tarsal tunnel syndrome, fat pad atrophy, heel pain, foot pain, plantar fascia rupture, lateral plantar nerve compression, calcaneal stress fracture, stress fracture of the calcaneus, bone tumor, bone cyst, osteomyelitis, spinal stenosis, prolapsed intervertebral disk, prolapsed intervertebral disc, arthritic inflammatory bowel disease, seronegative spondyloarthropathy, inflammatory arthritis, rheumatoid arthritis

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Contributor Information and Disclosures

Author

Vinod K Panchbhavi, MD, FRCS, FACS, Associate Professor, Chief, Division of Foot and Ankle Surgery, Department of Orthopedics, University of Texas Medical Branch School of Medicine
Vinod K Panchbhavi, MD, FRCS, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Foot and Ankle Society, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of England, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

Medical Editor

Heidi M Stephens, MD, MBA, Associate Professor, Department of Surgery, Division of Orthopedic Surgery, University of South Florida College of Medicine; Courtesy Joint Associate Professor, Department of Environmental and Occupational Health, University of South Florida College of Public Health
Heidi M Stephens, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, and Florida Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shepard R Hurwitz, MD, Executive Director, American Board of Orthopaedic Surgery
Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS, Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center
Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

 
 
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