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Plantar FasciitisYour Road to recoveryStarts Here
Copyright 2023 Vincent StaschiakAll rights reserved. No part of this book shall be reproduced or transmitted in any formor by any means, electronic, mechanical, photographics, including photocopying,recording or by any information storage and retrieval system, without prior writtenpermission of the publisher. No patent is assumed with respect to the use of theinformation contained herein. Although every precaution has been taken in thepreparation of this book, the publisher and author assume no responisbility for errorsor omissions. Neither is any liability assumed for damages resulting from the use of theinformation contained herein.Requests for permission to make copies of any part of the work should be mailed toPermissions, Vincent Staschiak, DPM, Mid-Ohio Foot and Ankle Specialists, 7100Graphics Way, Suite 3300 Lewis Center, OH 43035.
ContentsIntroduction............................................................................... 4What is Plantar Fasciitis........................................................ 5Symptoms of Plantar Fasciitis................................................ 6Causes of Plantar fasciitis......................................................7Diagnostic Procedures....................................................8-9Plantar Fasciitis Treatment Categories......................10-16-Conservative therapy, non-surgical options, andRegenerative Medication OptionsSurgical Options.........................................................................17Video Explanation......................................................................18Frequently Asked Questions...................................................19heelpainwellnesscenter.com
IntroductionThank you for your interest in Mid-Ohio Foot and Ankle/Heel Pain Wellness Center of America. This book isintended to help provide further education to you aboutplantar fasciitis and achilles tendonitis. By no means do we believe that this book takes the placeof visiting the office; however, it can be used as a goodreference source of information about treatments that canbegin at home and what treatments are used in the officesetting. This book is set up with different sections, online resourcesand videos that can be helpful to recovery from plantarfasciitis and achilles tendonitis. You can view each of theseresources by clicking the accompanying link. These are thesame resources that I give to my patients in the office. Ifyou are a visual learner, I would highly recommend utilizingthese resources.
Plantar Fasciitis is one of the most common causes ofheel pain. It involves inflammation of a thick band oftissue that runs across the bottom of each foot andconnects the heel bone to the toes known has the plantarfascia. When this band of tissue becomes irritated, paincan occur. This condition can develop gradually or havean acute onset. It can involve one or both feet. Plantar FasciitisWhat Is Plantar Fasciitis:
Symptoms of Plantar Fasciitis: The most common symptoms of plantar fasciitis are:Pain on the bottom of the heel Pain first thing in the morning when getting out of bedPain that increases over a period of timePeople with plantar fasciitis often describe the pain assevere upon rising in the morning and improves as theybecome more active during the day. Many patients statethat pain also occurs after periods of rest but decreasesonce they begin moving again. This occurs because theyare stretching the plantar fascia as they walk. For some,the pain is worse when they are on their feet for longperiods of time.
The plantar fascial band of tissue through long-termmicro-trauma leads to the tissue pulling away from theheel causing a gap which the body begins to lay down boneand a heel spur forms. Heel spurs do not hurt, they are notat the level of a joint where they are being impacted upon.Most importantly when the tissue pulls away from the heelit is tearing the blood vessels that are feeding the tissueand the process of calcification (drying of the tissue)begins causing the tissue to harden and lose its flexibility.In other words, the plantar fascia which is your foots shockabsorber is rusting. When the rust pocket gets big enoughit puts pressure on the infracalcaneal nerve which passesbeneath the heel and causes pain.Causes of Plantar Fasciitis:
Diagnostic ProceduresDiagnosis is made by palpating the bottom and the insideaspect of the heel eliciting pain along the nerve. Alongwith a physical examination we use state of the artdiagnostic equipment such as x-ray and diagnosticultrasound to complete the exam.X-rays are taken to check the alignment of the foot and thesize of the heel spur if one is present.
Diagnsotic Ultrasound:Diagnostic ultrasound is used to measure the thickness ofthe plantar fascial band of tissue and the color. The normal plantar fascial band of tissue is less than 4mmin thickness and has a light color, indicating good bloodflow.Damaged tissue is thicker and darker indicating traumaticdisruption of the foots shock absorber. Normalfascia3.9mmAbnormalfascia7.8mm
Conservative TherapyConservative therapy is effective in resolving heelpain in 80% of the population. This consists of steroidinjections, cushioned insoles, arch supports, padding,stretches, pain creams, and radial EPAT therapywhich consists of multiple sessions multiple times aweek. This therapy can be helpful in resolving acute orshort-term plantar fasciitis ( < 6months).
Non-Surgical OptionsAt Mid-Ohio Foot & Ankle Specialists/ Heel Pain WellnessCenter we use an FDA approved high-intensity shock wavetherapy machine called the Medispec. With one therapy offocused pressure waves, the tissue becomes flexible againand the blood flow will return to the area healing thedamaged plantar fascia thereby eliminating your pain over afew days to a few weeks. This procedure is done in the office under a local anesthesiato numb the foot in one 30- minute session. You go home inyour shoes and limit activity for 3 days. Some patientsrequire an additional shock wave depending on the severityand longevity of the plantar fascial damage. As it took time tocreate the injury, the healing process also takes time. This can be repeated usually after 4 months if there is lessthan a 60% decrease in the heel pain symptoms from the 1stprocedure, usually in about 10% of the patients, at whichtime there is a 98% success rate after the 2nd therapy. Whenreviewing the studies, total resolution of the heel pain maytake up to a year, but a huge decrease in the pain is noticedimmediately after the procedure. Unlike invasive procedures,with ESWT, you are walking the same day and back to workand activites in a few days.
Some patients may experience post-treatment discomfortwhen the local anesthetic wears off, usually from theinjections to numb the foot. This can be lessened with theuse of Tylenol and/or our specially formulated pain cream.We do not recommend ice, heat, or anti-inflammatories asthe healing process begins immediately and we do not wantto hinder the process. All patients are back in their shoesimmediately after the procedure and able to return to workand activities. We do prefer all patients rest for 3 days after(no high impact activities) to allow the initial inflammatoryprocess to subside. Recovering from ESWT:
When Should I Consider ESWT:If you have experienced your condition for more than sixmonths or have tried at least 3-4 other conservativetherapies with out success then you maybe a candidatefor the ESWT procedure. Waiting too long can lead toother problems such as foot, ankle, knee, hip, and lowerback pain due to altering the way you walk.
Regenerative MedicineHere at Mid-Ohio Foot and Ankle/Heel Pain WellnessCenter we specialize in Regenerative Medicine.Regenerative Medicine promotes the repair responseof dysfunctional or injured tissue using stem cells ortheir derivatives. Exosomes:Exosome Therapy is an effective solution to chronicdebilitating plantar fasciitis. Exosomes also help to repairtendon or muscle injuries by healing and strengtheningthe tissues by up to 40% thereby negating the need forlong term medication use or surgery. Exosomes areextracellular vesicles generated by all cells that carrynucleic acid, proteins, lipids, and metabolites which createpathways for intercellular communication. Thesemessenger cells release growth factors and otherbeneficial processes needed to rejuvenate the tissues.Exosome therapy is a form of regenerative medicine thathelps rejuvenate older stem cells with new, younger stemcells. Stem cells have the potential to repair, restore,replace, and regenerate cells in the body. After gettingthis therapy, the exosomes communicate new, healingmessages to your cells that tell your body to heal itselfthrough its own regenerative process.
Whartons Jelly is found in the umbilical cord and isknown for being rich in growth factors and mesenchymalstem cells. Stem cells have the ability to rejuvenate thestructures on which they are placed and also increasethe healing potential for soft tissue tears. Mesenchymalstem cells are different from the hematopoietic stemcells that come from the blood system. Research showsMSCs are geared toward connective tissue disorders andregenerative medicine and have increased healingpotential. We also recommend Whartons Jelly andexosome therapy for patients who have undergoneprevious surgeries and are still experiencing pain anddiscomfort on a regular basis to help repair structuresand soft tissue. Whartons Jelly:
Amniotic Injections:Amniotic injections are very helpful in the regenerativetreatment of arthritis symptoms throughout the lowerextremity. These injections have been shown to decreasethe constant pain and inflammation associated witharthritis instead of having surgery. Amniotic injections andgrafts have also been used to treat chronic wounds,sprains and strains in muscles, tendons and ligaments inthe foot and ankle.
Surgical OptionsMost surgeons are trained to perform an EPF orEndoscopic release of the plantar fascia which releases aportion or all of the plantar fascia, which is your footsshock absorber. You are put to sleep for this procedure ina hospital or surgery center. We DO NOT recommend thisprocedure!EPF Procedure:Once a surgeon performs the EPF the recovery period isquite different. Post Operative pain medication is needed vs tylenolwith the ESWTEPF requires 6-8 weeks off of work while you are backin your shoe same day with the ESWT procedure withminimal down time.The EPF procedure requires a 6-12 month totalrecovery time.After the EPF you will be dependent on a hard rigidarch support to prevent the collapse of the arch overtime.The EPF can lead to a flattening of the arch which willmake one leg shorter than the other causing lowerback, hip, and knee pain over time.
Video ExplanationsCheck out our video below for more informationFor additional information visit:heelpainwellnesscenter.com orscan our QR code Heel Pain Interview: Click Here
Frequently Asked QuestionsHow long does it take for me to notice a decrease inmy heel pain after the treatment/s?Most patients will notice a huge decrease in their symptomsalmost immediately after the 1st procedure and it willcontinue to get better everyday over the next few weeks. Are there any risks or side effects associated with thetreatment plan?After the ESWT treatment there may be some initialinflammation and discomfort over the next 24-48 hoursfrom the numbing injections. We recommend light activityfor the first 3 days to allow the procedure to properly takeeffect. How long will I be off of work or activites?ESWT does not require time off your feet but it isrecommended to rest for the first 3 days, as to where theEPF requires 6-10 weeks off work with 6 months to 1 yearrecovery time period.