siliconindia | | October 20209the foot will be more susceptible. Use of improper footwear may add to the problems. However, it doesn't always follow the above rules and practically anyone and everyone can get this con-dition in some point of life.Even the course of the disease is unpredictable. Usually it is a self-lim-iting disease, and it may disappear on its own after few weeks to months, but sometimes it may persist as nagging pain and may cause immense agony to the patient in routine day to day ac-tivities. Diagnosis of plantar fasciitis is clinical, but your doctor may advice you for an X-ray if the pain doesn't relieve in a few weeks. X-ray may be completely normal in some indi-viduals or may show a pointed bony enlargement at the bottom of heel, known as `spur'. Majority of patients respond well to conservative treatment like rest, an-ti-inflammatory medications and ice application. Physiotherapy exercises comprising of stretches of the Plantar Fascia and Achilles tendon are help-ful. In advanced cases, you may need devices for night bracing to keep the plantar fascia stretched at night, and to maintain it in lengthened position during sleeping hours. There are var-ious orthotics available to redistribute the body weight while loading the heel surface, like silicone heel pads, custom fit arch supports, gel pads and even air cushion heals, and they can be used judiciously as per the require-ment of the patient. Sometimes even after the best of the efforts, the pain may persist and then your physician will have to pro-ceed to the next line treatment. Local injection with steroid formulation at the site of pain is often helpful to re-duce the inflammation and alleviate the pain. The duration for which the effect lasts is variable, and adminis-tration of multiple injections in heel area is not recommended. There are options like injections of PRP (platelet rich plasma) or stem cell injections, however the effects are still under re-search and results are outcomes can-not be guaranteed. Modalities like ul-trasound therapy and extra corporeal shock wave therapy have been tried, but the results have not been consis-tent, and are not recommended. So steroid injections still remain the treat-ment of choice amongst the available options.In rare situations, the pain may still persist, and we may have to proceed with surgical options. The aim of the surgery is to detach the tight plantar fascia from the bottom of your heel bone. Removal of the bony spur may not be necessary to tackle the pain. Dr. Abhishek Nerurkar, Consul-tant Orthopaedic Surgeon, Hinduja Healthcare Surgical, mentions that with the advancing technology, this surgery can be done by minimally in-vasive techniques with an endoscope. As a result of the small incision, the tissue handling is minimal leading to faster recuperation of the patient. The fascia is seen under magnification and can be released precisely under vision. Patients can get back to their routine faster and improvement of quality of life is significant. If you have heel pain, please con-sult your Orthopaedic Surgeon early to get better outcomes. Listen to what your body wants to communicate with you. Stop activities that are causing pain, rather than pushing hard and causing more damage. Do not ignore the pain till it becomes chronic and unbearable, as it may lead to a longer recovery time. Believe me, you will be back in the game once you start the right treatment!! In rare situations, the pain may still persist, and we may have to proceed with surgical options. The aim of the surgery is to detach the tight plantar fascia from the bottom of your heel bone. Removal of the bony spur may not be necessary to tackle the painDr. Abhishek Arun Nerurkar, Consultant Orthopaedic Surgeon
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