What is Plantar Fascitis or Heel Spur Syndrome?
Heel pain is usually present during the first few steps in the morning and tends to ease until the next time the patient rests, sits or drives and tries to stand on their feet. Many patients describe this pain as 'a hot knife being pushed into my heel.' If left untreated, pain can become constant, even hurting when at rest. For some patients, the pain is so severe that they can no longer participate in certain normal activities such as work and sports.

What Causes It?
Plantar Fascitis (Heel Pain) is caused by a mechanical imbalance in the foot called pronation. Over-pronation causes the foot to roll in towards the arch and big toe area. There is a very strong, fibrous band on the bottom of the foot called the Plantar Fascia. The Plantar Fascia inserts in the heel bone and then spreads out and joins the toes. When the foot rolls in (pronates) the band must try and stretch, but it cannot, therefore, the fascia pulls at its insertion at the heel bone which causes swelling, hence pain. Over time, as the fascia continually pulls, it pulls away at the bone causing a heel spur. The size or presence of a heel spur does not always correlate with the amount of pain. One can have a heel spur with the absence of pain and vice versa!

Will It Go Away?
This is possible in some patients, however, it will tend to return much worse than the first episode. In most cases, the longer it is left untreated, the more chronic the condition and the more difficult it is to treat.

Am I A candidate For the Surgical Procedure (EPF)?:
If you have failed to obtain complete relief of heel pain with the use of conservative treatments, such as: heel taping, cortisone injections, anti-inflammatory medicines, physical therapy or PRESCRIPTION ORTHOTICS, then you may benefit from Endoscopic Plantar Fasciotomy. Remember, almost all patients are treated satisfactorily with proper PRESCRIPTION ORTHOTICS alone. Orthotics are required pre and post operatively. A complete consultation and examination will help determine your best option.

What Then?
If all of your symptoms go away with conservative care, then surgery will not be necessary. If however, pain and discomfort are still present after conservative treatment has been tried, then surgery is recommended.

How Is This Procedure Different?
In traditional Plantar Fascia Surgery, a large open incision is made to release the tight fascial band and remove the heel spur if present. Studies have proven that the heel spur itself does not hurt, but rather the inflammatory response due to the constant pulling is what hurts. Consequently, spur removal is not necessary when Endoscopic Plantar Fasciotomy is utilized. EPF is performed by inserting a highly specialized micro camera into the heel area, visualizing the fascia and detaching a portion of it from the heel bone where it is pulling. Usually 5 or 6 stitches are required.

What Results Can I Expect?
Most patients return to their regular shoes in 1-3 days. Most return to work after the first week and return to sports activities after six weeks. Everyone heals differently. Other factors such as severity of condition, age, weight and occupation can contribute to healing times. Patients can feel relief anywhere from one day to one year.

What Are The Risks?
Fortunately, there are few complications that can be resolved by careful post-operative treatment. As with all surgery, no procedure is risk free and there is absolutely no guarantee as to its success. The most common risks inherent to this procedure include infection, numbness, delayed healing with aching in the heel or instep area.

What Are The Fees?
Podiatric Surgery is not covered under Ontario's Provincial Health Plan. Certain third party insurance policies may cover all or a portion of Endoscopic Plantar Fasciotomy. The surgical fee will be discussed at the time of your consultation.

Why Choose Our Clinic?
Hartley Miltchin D.P.M. is trained and qualified to perform this very intricate procedure. He is Board Certified in both Podiatric Medicine and Surgery. He was also trained by the developer of EPF and was the first in Canada to perform the procedure.

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