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Happy Feet

Karen Mason

For those dealing with plantar fasciitis treatment can provide fuller more active lives.

Here in the mountains we jam our feet into stiff ski boots hammer them on hikes and squeeze them into tiny climbing shoes. What are some common ailments of the active community and why is it so important to take care of our feet?

“Our feet form the base of our upright existence” explains Dr. John Paul Elton a Harvard-trained foot and ankle specialist with Vail-Summit Orthopaedics. “Whether we are walking running or standing it is our feet that support our bodies help us balance and propel us forward in our activities.” The feet and ankles are the most complex part of our locomotion and are therefore susceptible to many ailments he adds. Because of this we need to pay a bit more attention to caring for our feet and ankles.

Active individuals are at risk of developing problems with their feet. Dr. Elton says some problems develop over time with increased activity such as plantar fasciitis tendon problems or stress fractures. “We see these problems more with repetitive motion activities such as running and hiking.” Other problems result from trauma such as Achilles tendon ruptures ligament tears or ankle fractures. “These injuries are more common with court or field sports like football tennis and soccer as well as with snow sports like skiing or snowboarding.”

Preparing for the day's activity be it training competition or standing all day at work should start with the right equipment — namely your footwear. Dr. Elton recommends making sure your gear fits appropriately. “If those running shoes have too many miles on them then it's time for some new ones. If they are right out of the box they will typically need a 'break-in' period.”

Outdoor enthusiasts are often so eager to jump into the new season that they go straight from skiing to biking without missing a beat. “If it's the transition between seasons or you're trying an entirely new activity your body will need a 'break-in' period. Start those new activities slower and easier and build-up gradually to the level you want to get to. We are prone to 'training errors' when we jump right into the new sport and don't allow our feet to get used to the new stresses that activity places on them.” In general Dr. Elton says transition periods become more important as we age as our tissues are more prone to reconditioning and degenerative injury.


Local surgeon Dr. Elton performs a minimally invasive procedure for healing plantar fasciitis.

Patients with plantar fasciitis tend to have symptoms referred to the plantar surface of the foot or the bottom of the heel. The classic symptom of plantar fasciitis is when the first few steps out of bed are painful. The pain can be dull and aching or excruciating to the point of causing someone to hobble or consider crawling their way to the bathroom. “Symptoms typically ease up after the first few steps but for someone who stands a lot or does a lot of activity they can actually get worse. The pain tends to get better with rest.”

Patients who are at risk for plantar faciitis often have a tight Achilles tendon or spend a lot of time on their feet. They are runners or folks who maybe have gotten a little overweight. The disease typically affects just one side but it can occur in both feet.

The plantar fascia is a thick band of tissue that attaches to the heel bone and runs underneath the foot all the way out to the toes. There can be some associated inflammation but the condition is primarily a degenerative condition of the plantar tissue that results from repetitive stress injury or aging. Bone spurs often form at the attachment site of the plantar fascia to the heel but are generally not considered to be the cause of the condition.


The typical non-surgical treatment for plantar fasciitis is multi-faceted and tailored to the individual patient. The physical exam patient history and x-rays will determine which regimen will be most effective. Non-surgical treatment may include some or all of the following: stretching and strengthening exercises physical therapy supportive footwear anti-inflammatories orthotics heel cups and a night splint to keep the Achilles tendon and plantar fascia stretched out throughout the night.

Dr. Elton says surgery is rarely needed for treating plantar fasciitis. About 90 percent of people will get better with non-operative options after about 6-10 months of treatment. “This can be particularly trying for active patients who don't want to put their activities on hold for such a long time” Elton says.

Second line treatments for someone who isn't getting better after trying these initial treatments might be candidates for shock wave therapy or steroid injections.

“Like most orthopaedic treatments there's not one treatment regimen that works for all people. We tailor the treatment plan for each patient.”

But there are those extreme cases where surgery does become necessary. And when that happens Dr. Elton says there are a couple different surgical options for treating plantar fasciitis. “The classic approach is to make an incision to expose the plantar fascia and remove the diseased part. At the same time we are releasing the nerve that's getting pinched.”

However there is a new minimally invasive procedure for certain patients. “With the minimally invasive technique we make a tiny incision just over the heel. An ultrasound device is used during the procedure to identify the exact location of the diseased tissue. Then we insert a small device that simultaneously breaks-up and removes the diseased tissue. The procedure can be performed in about 15 minutes with local anesthetic.” Patients can walk on the foot immediately and most patients return to full activities within four to six weeks.

Dr. Elton points out that not all patients are candidates for minimally invasive treatment because some will have related nerve irritation or severe Achilles tightness that may require a separate procedure to correct.

The most important thing when treating plantar fasciitis is to not give up says Dr. Elton. “Be patient and remember that things will get better.”

For more information contact Dr. John Paul Elton at Vail-Summit Orthopaedics | (970) 569-3240.