We should all live by the motto: “Feet don’t fail me now.” So what’s the cause of excruciating foot pain with a first step? Generally, it’s a medical condition directly related to foot heel spur syndrome known as plantar fasciitis. Medical foot injections composed from a steroid broadly known as cortisone can be used to ease the pain of plantar fasciitis. This type of steroid is not an enhancement-performance drug and is legal in the United States and international anti-doping regulations. According to Dr. Cathy Fieseler, president of the American Medical Athletic Association, “Cortisone is a wonderful, terrible drug.” It is wonderful because it knocks out the precise inflammation in the affected area of the foot. This relief of foot pain can be perceived as immediate when combined with short and long-acting local anesthesia. However, if the issue which caused the inflammation initially is not resolved the foot discomfort will inevitably return.
In podiatry practice, the rule of thumb for medical foot injections is no more than three cortisone injections in the same area during a one-year span. Overuse of corticosteroids can in fact be a terrible thing. While cortisone certainly does eliminate foot pain and inflammation, it’s also erosive to soft tissue. Consider this medical fact: cortisone is also used to reduce keloids and does so by breaking up excessive scar tissue formed in lesions like keloids. However, cortisone cannot discriminate scar tissue from healthy tissue, therefore, it will damage joint cartilage, rupture tendons and cause fat-pad atrophy. What’s a fat pad? In the foot, a healthy fat pad plays an important role in shock absorption in the heel and the ball of the foot. Too many cortisone injections to the area puts the fat pad at risk and may trigger additional foot problems which can be permanently worse than plantar fasciitis.
If someone has been suffering with plantar fasciitis for more than a year and exhausted all conservative foot-pain therapy such as, but not limited to: stretching exercises, shoe inserts, foot splints, physical therapy; then, cortisone injection surgical intervention should be considered. Frankly, this option is under-utilized. Most of us cringe at the thought of foot surgery and being out of commission. But the truth is, recovery is speedy and the relief of foot pain can be instant and, more importantly, permanent.
In order to understand why surgical intervention is a viable option for foot-heel-pain sufferers, it’s necessary to understand what plantar fasciitis is. The plantar fascia is a taut broadband, ligament-like structure located in the bottom of the heel. Plantar fascia strength can be comparable to that of duct tape: super strong and tough to tear. Extremely flexible flat feet, for example, can easily acquire micro tears in the plantar fascia. Where the split occurs elicits the inflammatory process which in turn produces agonizing foot pain. The surgical procedure of choice is known as “plantar fasciotomy.” This simply calls for the foot surgeon to make a small incision through the plantar fascia to relieve tension. By doing so, the plantar fascia is elongated and no longer taut and prone to tearing. Best of all: the incision can be closed with a few stitches and the patient can return to work the next day absolutely pain free.