Heel pain – plantar fasciitis

Causes of plantar fasciitis include:

• Increased tension and contracture of the posterior calf muscles
• Training overload, especially speed training and sports requiring frequent jumping, such as volleyball and basketball
• Constant running on hard surfaces – asphalt or concrete
• Improperly selected or worn-out running shoes
• Flatfoot
• Excessive foot pronation

Conservative treatment:

Initially, anti-inflammatory medication improves symptoms in the early stage. Procedures such as ultrasound, iontophoresis and shock-wave therapy are usually also helpful.

The basis of treatment is a set of exercises stretching the plantar fascia and calf muscles. These should be performed regularly and with appropriate intensity for up to 12 weeks. Relaxing the fascia with suitable myofascial massage techniques may also help.

Choosing suitable sports footwear according to the foot profile and limb axis is also essential. Remember that footwear wears out during training.

If the limb axis or plantar-fascia function is abnormal, orthopaedic insoles correcting foot alignment may be necessary.

PRP (GPS) therapy – platelet-rich plasma – uses targeted ultrasound-guided injections to deliver plasma precisely to the painful site. The preparation releases growth factors around the diseased plantar fascia. These reduce inflammation and stimulate fascial tissue regeneration. The procedure is performed on an outpatient basis.

Surgical treatment:

If conservative treatment is ineffective and pain persists for at least 6 months, surgery is indicated. At our hospital, we perform percutaneous plantar-fascia release using minimally invasive surgical techniques (MIS). Special instruments are introduced through a small skin incision of approximately 3–4 mm to release the plantar fascia. A heel spur, often accompanying chronic plantar-fascia inflammation, can also be effectively removed during the procedure. The operation is safe, symptoms resolve permanently and postoperative care is limited to walking in orthopaedic footwear.

In foot surgery, ensuring a pain-free operation and minimising postoperative pain have always been major challenges.

It is commonly believed that recovery after foot surgery, especially hallux surgery, is very painful.

There are many options for anaesthesia during procedures on the foot.

Modern anaesthesiology aims, wherever possible, to use regional anaesthesia techniques – from central blocks such as spinal and epidural anaesthesia, commonly known as lumbar anaesthesia, to peripheral nerve blocks at various levels performed under ultrasound guidance, especially when operating on one foot.

The possibility of using a particular type of anaesthesia depends mainly on the extent of surgery and any coexisting conditions.

The final choice of anaesthesia is agreed with the patient during the preoperative assessment interview.

Using ultrasound in anaesthesiology to perform peripheral nerve blocks has enabled highly precise regional anaesthesia.

Our many years of experience have changed our perioperative approach, both to anaesthesia itself and to the postoperative period.

For foot surgery, peripheral nerve anaesthesia, known as an ankle block, means injecting a local anaesthetic around the nerves at the appropriate level.

These anaesthetics are highly precise because the nerves responsible for pain sensation are clearly visible on ultrasound and medication delivery is fully controlled.

This can substantially reduce or even eliminate the need for pain medication early after surgery.

For many patients, one of the most important advantages is that sensation above the knee is preserved in the operated leg and, most importantly, lumbar anaesthesia is avoided, which patients do not always accept.

Another important advantage is that walking can begin very soon after the procedure.

During the postoperative period, administering pain medication at regular intervals under ultrasound guidance around the nerves responsible for pain enables patients to pass through this period as comfortably and painlessly as possible.