What Should I Expect from Plantar Fasciitis Surgery?

Patellar fasciitis

Western Medicine Name: Patellar fasciitis
Disease site: foot

Main cause: Overload exercise
Contagious: Non-contagious

Pathological definition of patellar fasciitis

Causes of patellar fasciitis

Fasciitis refers to the aseptic inflammatory response of muscles and fascia. When the body is stimulated by external adverse factors such as wind chills, fatigue, trauma, or improper sleeping position, it can induce an acute attack of myofasciitis, shoulder, neck and waist Acute or chronic injuries and strains of the muscles, ligaments, and joint capsules are the basic causes of the disease. Because of the inadequate treatment in the acute phase, the patient became chronic; or because the patient suffered from repeated irritation, wind chills and other bad stimuli, he could repeatedly or intermittently experience chronic muscle pain, weakness, and weakness. The etiology mechanism is caused by inactive blood capillaries and poor microcirculation of muscle blood ^[1] .

Definition of patellar fasciitis

The plantar fascia is a part of the plantar aponeurosis, which is the thickened part of the central plantar deep fascia. It starts from the medial process of the calcaneal nodule and plays an important role in maintaining the arch of the foot. Under repeated traction of rhythmic stress, such as long-distance running, jumping exercise, troop training, obstacle crossing, platoon, especially forward training, and long-term continuous standing, etc., increase the load on the front of the plantar, resulting in the abdomen and tendon surfaces of the plantar muscles. Due to excessive movement, pulling and squeezing of the dense connective tissue of the fascia, ischemia of the fascia, chronic fibrous tissue inflammation at the attachment site of the patellar tendon and calcaneal nodule, and bone spurs are formed in the future. This kind of spurs can cause increased tension in the abductor hallucis, short toe flexor, and medial patellar fascia, or cause synovial bursitis. Heel pain is called patellar fasciitis, also known as palatalgia. ^[2]

Patellar fasciitis pathology

Modern medicine believes that when the diaphragmatic fascia is subjected to a force exceeding its physiological limit, this repeated long-term overload will induce inflammation, form degeneration, fibrosis, and cause diaphragmatic fasciitis. Over time, condylar fascia contracture causes continuous traction damage to the calcaneal attachment, and the fibers of the ligaments and fascia are constantly torn. To strengthen the body here, calcium deposits and ossification at the attachment are caused. The formation of bone spurs ^[2] .

Symptoms of patellar fascia

The typical symptom is that when you stand and walk in the morning or after a long break, the heel and foot pain gradually appear. Physical examination may have tenderness of the entire plantar fascia. Pain and tenderness are more pronounced during passive back extension.

Diagnosis of patellar fasciitis

Diagnosis according to the diagnostic criteria in Practical Orthopaedics. Acute injuries often have a history of trauma. For example, when walking on the foot suddenly stepping on a hard object or accidentally walking too hard on the heel when going downstairs, chronic injuries are more common in middle-aged and older people. Women are more frequent than men and have slow onset May have even several years of medical history, the clinical manifestations of plantar pain, dare not walk, check the middle of the plantar showed obvious tenderness, refusal to press, lameness.

Sacral Fasciitis Treatment

Rest: Avoid running and other activities that aggravate pain. Ice pack: Wrap ice cubes on the heel and soles with towels, 4 times a day, 15-20 minutes. Medication: Oral aspirin or non-steroidal anti-inflammatory Analgesics, topical injection of steroid hormones when necessary;

Braces: Use the braces to stay in a neutral position while sleeping at night. Orthopedic appliances: Use special foot pads to support the mid arch area. Body therapy: Start stretching exercises as recommended by your doctor to lengthen the Achilles tendon and plantar fascia.

Chinese medicine treatment of patellar fasciitis

Commonly used non-surgical treatments include: insoles and fillers, orthopedic shoes, physical factor therapy, stretch therapy, oral non-steroidal anti-inflammatory analgesics, local closure of tender points, extracorporeal shock wave therapy, local injection of botulinum toxin, etc.

Local closed therapy : First, locate the injection point, take the tender point as the injection point, conventional iodine and alcohol disinfection, spread a towel, press the pain point with the left thumb, and pierce with a needle in the right hand. Generally, there is a local soreness, and no withdrawal. After the blood was injected, a mixed solution of 2% lidocaine + prednisolone acetate + vitamin B1 + vitamin 12 was injected, and 3-4 ml of the mixed solution was injected at each pain point, and local massage was performed for 5 minutes after injection. Once a week, it is advisable to inject 2-3 times generally. Avoid strenuous activities during treatment.

Topical plaster : Chinese medicine believes that the etiology and pathogenesis of plantar fasciitis are kidney deficiency and righteousness, and cold and dampness. The lower foot is more affected by cold and dampness, and the deficiency of kidney yin and kidney yang leads to insufficient righteousness. The evil of cold and dampness enters by deficiency and stagnates, which leads to depression of veins and blood stasis, internal resistance of blood stasis. The method is a topical plaster. The topical plaster is applied to the heel muscle surface to stimulate nerve endings, dilate blood vessels, promote local blood circulation, improve nutrition of surrounding tissues, and achieve swelling, anti-inflammatory and analgesia purposes.

Nerve block : At the midpoint of the line between the fibula head and fibula neck, when the fingers slide on the skin surface, the common peroneal nerve can be touched to roll on the fibula neck. After disinfection, the operator fixed the common peroneal nerve between the middle finger of the left middle finger and the index finger. The right hand held a 3 cm long 7-gauge short needle to puncture the bone. When stabbing to the fibula neck, a strange feeling usually appears. If there is no strange feeling, the drug can also be injected at this point. Then ankle tibial nerve block was performed, and the posterior tibial artery was determined on the posterior side of the medial malleolus. The surgeon pressed the artery under his finger with his left hand finger, and punctured the posterior edge of the posterior tibial artery along the edge of the finger with a 3 cm long 7-gauge needle in his right hand. If there is an abnormal feeling, you can inject the medicine. If there is no abnormal feeling, you can pierce the needle all the way to the bone and then withdraw the injection by 0.5 to 1.0 cm. Injectable drugs: bupivacaine, triamcinolone, vitamin B12.

Nerve block therapy for patellar fasciitis has been clinically observed; its characteristics are:

(1) The operation is simple and easy to implement, and can be implemented in outpatient clinics, teachers' hospitals, and health teams without hospitalization;

(2) The curative effect is reliable;

(3) Small side effects, safe and economical. But pay attention to the following points: the puncture location must be accurate, not to puncture the nerve, not to inject the drug into the nerve; if there is a strange feeling, you need to withdraw the needle a little and then inject the medicine.

(4) Shock waves: The efficacy of external shock waves in treating chronic plantar fasciitis has been confirmed. Mechanism of action: Some people believe that high-energy radon shock waves selectively destroy unmyelinated sensory nerve fibers; while low-energy shock waves can release peptides such as calcitonin gene-related peptides. A neurogenic inflammatory response is generated locally, which in turn inhibits the conduction of sensory nerve endings. It can also cause changes in local blood flow in the brain, adjust pain memory, reduce the response to local pain stimuli, and thus play a long-term analgesic effect.

(5) Small needle knife: The principle of small needle knife treatment is to remove subperiosteal and loosen the adhesion caused by inflammation, so as to promote the absorption of inflammation and achieve the purpose of treatment. Therefore, the clinical treatment with this method can achieve immediate results, but the periosteum after release can be re-adhered and pain recurrence, it is not uncommon in clinical practice.

The patient was placed in the prone position. The doctor carefully found the tender point and the cord-like reactant under the heel of the patient, and then routinely disinfected. A 1.5-inch needle was inserted from the distal end of the cord-like reactant of the calcaneal nodule into the skin at a 15 ° angle The part must be accurate, such as a string-like reactant in the puncture, the patient should have a sharp sore needle; then the needle is punctured flatly towards the calcaneal tuberosity, and the touched rope-like pattern is lifted with a small 3-5mm insertion method The needle can be ejected after the reactant is stimulated once, and the whole process should not exceed 1 minute. On the second day after acupuncture, massage therapy can be used to consolidate the effect, and the effect can be checked after 1 week. If acupuncture is not cured, acupuncture can be repeated.

Sacral Fasciitis Surgical Treatment

Through non-surgical treatment, the symptoms of most patients can be relieved within 12 months, but 10% of patients still have poor curative effects, and about 5% of patients need surgery, and most of them are bone resection.

Fasciitis Care

Fasciitis do not take a healthy walk

Patients with plantar fasciitis should never assume that walking a healthy path can resolve foot pain, but will worsen the inflammation. Therefore, people with this problem, it is best not to step barefoot and avoid walking on uneven roads.

Fasciitis do not do foot massage

Many people like to find someone to do a foot massage, thinking that the more painful the better, clinical doctors have found that many people are doing foot massage, according to the plantar fasciitis. The doctor said that people should not bite the scalp when receiving foot massage. When the pain is unbearable, they must ask the masseur to put light or stop.

Fasciitis Use foot guards while sleeping

When you sleep, put a guard on the soles of your feet to keep your ankles at 90 degrees. Do not put them down so that the fascia will not be so tight, and the first step to get up will not hurt.

Fasciitis choose sports air shoes

To change the habit of wearing shoes, don't wear slippers, because slippers are not complex, wear sports shoes. But there are two important points. One is that the heel of the shoe has a bag back, which can shape the fatty tissue at the bottom of the ankle like a waist. The second is that the sole must be soft so as not to touch the pain point.