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  • Dr. Zappala

Plantar Fasciitis Solved

Plantar fasciitis can be a very painful condition that limits your activity levels, and in some cases, will force you to stop exercising. Most people think of this as a foot condition and you would be correct in that the pain is in the foot or heel, but the problem involves the entire body. The plantar fascia is contiguous with the rest of the fascia in the leg and is subject to overload for a variety of reasons including weak or deactivated lateral hip stabilizers. This occurs frequently in runners and walkers you suffer from something called valgus collapse. This is where the knee gets inside the hip and ankle line during activity causing excessive medial tibial rotation and overloads the plantar aspect of the foot. This overload can cause a thickening of the plantar fascia and lead to pain, gait compensations, heel spurs, etc.

The traditional treatment for plantar fasciitis includes stretching, rolling a frozen water bottle on the bottom of your foot, orthotics, night splints, and more. The problem with these treatments is that they are being performed without visualizing the plantar fascia and they are only directed to the foot.

The best way to image this condition is with something called MSK Ultrasound. You are probably familiar with other types of Ultrasound used during pregnancy, this is similar but is optimized for musculoskeletal structures like fascia, tendons, joints, and ligaments to name a few. This case demonstrates the use of MSK Ultrasound to both diagnose plantar fasciitis and to treat it through a procedure called Tenotomy. The initial scan revealed a significant thickening of the plantar fascia coupled with a heel spur, which is the body's response to the repetitive stress to the tissues. This is the original scan.

A Tenotomy procedure is basically using the guidance of the ultrasound to micro-irritate the injured tendon. This induces an inflammatory response, thereby initiating blood flow and cell signaling. This is necessary because tendons, fascia, and ligaments are poorly vascularized structures, meaning they have a poor blood supply. If a tissue with a poor blood supply gets injured, it doesn't heal and leads to chronic pain.

The results were achieved with a combination of Tenotomy and targeted rehabilitation protocols that were performed twice per week over the six-week period. This reduction in the thickness of the plantar fascia also indicates that tissue is healthier and more elastic. This is the follow up scan below.

As the tissue thickens from trauma, it becomes less elastic and forgiving and more like canvas. Canvas is not very forgiving and often tears which is essentially what is happening with chronic plantar fasciitis. This patient follow-up scan was performed after the patient underwent our hands-on rehab protocols and is ready to transition to return to running protocols.


This was all accomplished in a patient that suffered for years and was complete in 6 weeks.

If you or someone you know is frustrated with chronic plantar fasciitis, give us a call at 949.631.5226 ext 10 and see if South West Health Spine & Sport can help you with your foot and lower extremity challenges.

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