Heel Pain Surgery Perth
Plantar Fasciitis Treatment
What is heel pain?
Heel pain is a broad term used to describe pain and discomfort in the bottom of the heel associated with standing, walking, jumping or other weight bearing activities.1 It is a complex condition that can be caused by bony prominences, soft tissue injury, or even nerve entrapment. Heel pain has a negative impact on both foot and general health on almost all Australians, regardless of age, sex or body shape.2
A specific structure that is often implicated in heel pain is the plantar fascia, a thick band of connective tissue that stretches from the base of the heel to the bottom of the forefoot. This structure can become injured, tight, or torn, and the inflammation that accumulates as a result causes pain. The term ‘plantar fasciopathy’ refers to any injury to this structure.
Symptoms to look out for are:
- Pain in the bottom of your heel while standing or walking
- Pain with first steps in the morning when you get out of bed
- Pain at the end of the day when your feet are tired
- Sharp pain with rapid movements like running or jumping
- Tightness along the inner arch of your foot that feels like a taught string
- Redness or swelling under your heel or in the inner arch of your foot
Historically, pain in this area has also been associated with a prominent bony spur on the heel. These spurs can develop over time and has been referred to as Heel Spur Syndrome. While there has been debate about the role of spurs in heel pain, modern research demonstrates that heel spurs commonly coexist with heel pain and in some cases removal of the bony spur is needed to relieve symptoms.3
Heel pain can occur at the same time as other conditions in the foot, for example the classic 1st toe bunion and flat feet can be associated with heel pain. Often these conditions exacerbate each other and require that the foot be treated as a whole.
If the pain under your foot is significant or affecting your daily or sporting activities your foot should be examined by a Podiatrist or Podiatric Surgeon who are exclusively trained foot and ankle specialists. Dr Pocklington can provide expert assessment and treatment of all aspects of heel pain.
How is heel pain treated?
Depending on the cause heel pain can be treated conservatively or with surgical intervention, but all procedures aim to reduce pain and increase function. It is important to consider conservative treatment before pursuing surgical options, because often conservative treatment can significantly alleviate symptoms and in some cases resolve the condition.
Dr Pocklington is both a Podiatric Surgeon (foot and ankle specialist surgeon) and trained podiatrist with extensive understanding of the form and function of the foot before and after surgery. This includes consideration of conservative as well as surgical intervention and the overall function (biomechanics of your foot).
Conservative treatment of heel pain includes intrinsic muscle strengthening, stretching, taping, custom orthoses, low level laser therapy, extra corporeal shockwave therapy, corticosteroid injection, and more. Heel pain is often associated with a problematic foot architecture or other injury to the foot or ankle and it is important to consider the foot’s function as a whole.
There are many options available for the treatment heel pain and Dr Pocklington can fully assess your feet to determine which treatment is best for you.
When should I consider heel pain surgery?
If conservative measures are not able to alleviate your discomfort or if there is significant pain interfering with normal activities surgical intervention should be considered. Heel pain is a complicated condition and surgical methods also vary considerably. It is important to discuss which treatments are available to you with a Podiatric Surgeon or podiatrist to allow you access to the full range of procedures.
The goal of surgery is to restore and maximise function of the foot as a whole. The key result is reduction or resolution of pain and a healthy return to normal activities and footwear. As a Podiatric Surgeon, Dr Pocklington is a foot and ankle specialist trained extensively in procedures used to treat heel pain and can assist you in deciding whether surgery is right for you.
What Does Heel Pain Surgery involve?
Surgery for heel pain generally falls into two categories, but a combination of the two procedures is common:
- A partial or complete fasciotomy (a surgical cut and release of the plantar fascia to reduce tension)
- Heel spur resection
Both procedures can be performed as a minimally invasive surgery, limiting the skin incision and subsequent scaring to as little as possible. The fasciotomy involves a surgical cut to the plantar fascia, which is often taut and inflamed. Alternatively, the heel spur resection involves shaving the heel bone down to reduce or remove the spur and relieve any associated pressure on the surrounding soft tissue. More uncommonly, a plantar fascia may be torn. In these cases, surgical repair of the fascia may be required.
Each procedure is appropriate for certain presentations and severity of condition. Similarly, each has advantages and risks that Dr Pocklington will discuss with you in detail prior to your surgery. Most procedures take between 15 minutes and half an hour to perform. Anaesthetic injections are used to numb your foot locally in all cases, but an anaesthetist will also provide either a general anaesthetic or IV sedation.
Care and Recovery After Surgery?
Heel pain surgery is usually a day procedure allowing you to immediately weight bear on your foot in a stiff sole surgical shoe. Sometimes people stay overnight at a private hospital and return home the following day. Generally, pain relief after surgery involves a combination of painkillers and anti-inflammatories, but significant medication is often unnecessary. Paracetamol is usually all that is required within the first week.
Healing usually occurs 3 to 4 weeks after the surgery and during this time restricted activities, including time off work is recommended. Dressings are removed and replaced at 1 week, giving you an opportunity to see your progress and discuss it with Dr Pocklington. Sutures are usually removed at 2 weeks. The process of healing after surgery is important and requires ongoing attention from your surgeon. A podiatric range of motion exercise and stretching rehabilitation program begins immediately to ensure function is returned to the foot and your life as soon as possible.
Please book online to speak with Dr Pocklington about heel pain surgery.
Care and Recovery After Surgery
Usually lesser toe surgery is a day procedure allowing you to immediately weight bear on your foot in a stiff sole surgical shoe. Sometimes people stay overnight at a private hospital and return home the following day.
Pain relief after surgery generally involves a combination of painkillers and anti-inflammatories, but significant pain relief is often unnecessary. Paracetamol is usually all that is required within the first week.
If there has been a surgical cut to the bone, healing usually occurs 6 to 8 weeks after the surgery and during this time restricted activities, including time off work is recommended. For soft tissue only procedures recovery is faster. Dressings are removed and replaced at 1 week, giving you an opportunity to see your progress and discuss it with Dr Pocklington. Sutures are usually removed at 2 weeks. The process of healing after surgery is important and requires ongoing attention from your surgeon. A podiatric range of motion exercise and stretching rehabilitation program begins immediately to ensure function is returned to the foot, toe and your life as soon as possible.
Please book online to speak with Dr Pocklington about lesser toe contracture correction.
- Riel H, Cotchett M, Delahunt E, Rathleff MS, Vicenzino B, Weir A, Landorf KB. Is ‘plantar heel pain’a more appropriate term than ‘plantar fasciitis’? Time to move on.
- Irving DB, Cook JL, Young MA, Menz HB. Impact of chronic plantar heel pain on health-related quality of life. Journal of the American Podiatric Medical Association. 2008 Jul 1;98(4):283-9.
- Menz HB, Thomas MJ, Marshall M, Rathod-Mistry T, Hall A, Chesterton LS, Peat GM, Roddy E. Coexistence of plantar calcaneal spurs and plantar fascial thickening in individuals with plantar heel pain. Rheumatology. 2019 Feb 1;58(2):237-45.
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