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Sunday, April 5, 2015

Heel Pain: Email Advice

Ive got a question I have been seeing a local doctor and he has gave me a series of 3 cortisone shots in the side of my heal no spreading it around just a prick and done. Now he is telling me that he needs to go in and cut the fascia. I am not comfortable about this. Is there any other options???

Limping in Illinois

Dr Blake's comment: 
     Hey Limping, thank you so very much for the email. And, sorry you are limping!! With perhaps less than 1% of all plantar fasciitis cases needing surgery, I look at this with a bit (a lot) of caution. The plantar fascia is the 3rd supporting structure for your arch (after the ligaments and muscles/tendons), and there are cases of arches collapsing following surgical release (very small percentage also). However, that means you should consider plantar fascia release only if all the stones are turned over. Definitely get some other opinions, but do not tell anyone about what this doc wants to do. Only tell them what you have had done that has not worked so far, and what are your options. Cortisone is part of the Immobilization/Anti-Inflammatory Phase where you are trying to achieve that coveted pain free environment (0-2 level pain). While you are getting the shots (or physical therapy, or a home program of icing and contrast bathing and NSAIDs, or a combination of these things), you should be getting protected weight bearing inserts like orthotics. You may need a removable boot like an Anklizer (purchase online), or need to tape every day ( Until the pain is under control, I would avoid stretching the achilles and plantar fascia since you may have a plantar fascial tear. An MRI would be wonderful to see what is really going on. If you can not get a referral, you can check the AAPSM website for sports medicine podiatrists. It typically is a good source. 
     You may need surgery, but I would step back, get some opinions, and see what people say. I hope this helps you some. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.