Question
I am a 16 year old athlete who has been suffering from an extreme case of plantar fasciitis for over a year and a half, and trying the least invasive forms of treatment recommended by three different specialists. I am very active and you can find me playing some sort of sport year round. It started a year and a half ago but was nowhere near as painful as it is now. I continued playing and would ice after practice or games. As it got worse I began seeing our trainer for tape jobs to add support to my foot and ankle. The pain continued no matter what we tried. I had x-rays taken and with no signs of serious damage custom made orthodics were created. This only worsened the pain and caused other areas to feel pressure and sharp pain. The pain began to become so unbearably severe that I could not walk down the court without it bringing tears to my eyes. Playing sports my entire life I have been taught the difference between a burn and a legitimate searing pain when something is truly wrong. Even with the anti-inflammatories my heel and arch would swell up, no one I went to had seen anything like it before. Taking notice to how much pain I was in and that it was starting to effect my performance I was put on forced rest after a year of playing through it. I went to see another specialist who wrapped both feet in what can only really be described as a soft cast. He then made me start physical therapy. Three months produced no results so MRIs were ordered because of my "Bilateral posterior tibial dysfunction". The results showed there was a cist on one tendon but that did not explain why both feet were in excruciating pain. I also have an extra bone in my right foot. Because of this it was ruled inconclusive and I was referred to another specialist in a larger city. I have seen him twice in the last seven weeks. The first time he tested me for rhuematoid arthritis just to rule it out and it came back negative. He then placed me in a fiberglass cast for seven weeks to cause my calf to atrophy and immobilize my foot. Because this form of treatment was not as effective as he had hoped he began talking surgery. I was given three possible options, PRP, surgery to cut my plantar fascia or surgery in which the outer muscle on my calf would be detached and placed higher up to relieve tension. I have spent the last seven or eight months doing everything possible to find out it was basically a waste of my time, you can imagine how frustrating this is. So now I am trying to research each option, find out the benefits and the risks, to make sure I can resolve this problem as soon and effectively as possible. I would love some expert advice on the best option for me. I am young and don't want to have to continue to struggle with this, I honestly don't care about scars but being an athlete recovery time is a major factor. What are the possible options and which would you suggest I try? Thank you for you time.

Answer
This Chicago, South Loop & Elmhurst Podiatric Orthopedist of AnklenfootCenters.com says.......

Dear Shelby,

Posterior tibial tendon dysfunction will lead to lowered arches and sometimes plantar fasciitis.
A conservative treatment would be different orthotics with an ankle brace and shoe with a heel lift.
That said-If you need surgery and you truly have posterior tibial dysfunction.........
 all surgeries have RISKS and rewards! Make sure whatever surgical opinion you receive is from a podiatrist who is Board Certified in Foot & Ankle Surgery and has done lots of surgeries over many years on the procedure they may recommend. Look at the other patients in the waiting room and see if they are happy with their results. If you go to an orthopedist-make sure they did a Foot & Ankle Fellowship.
I cannot comment on the specific surgery since I am unable to to see you in person.
Do not have the surgery to cut the plantar fascia-it will make posterior tibial tendinitis worse.
Skip the PRP. Recent strong studies show that it doesn't work-and does not address the foot & ankle biomechanics(the function of the bones and muscles and their specific interaction as you walk).
Whatever surgery you have will probably take 6-9 months before you can compete again. You may still need to wear orthotics.
The surgery needs to address the posterior tibial tendon dysfunction and the biomechanics of the problem. The surgeon needs to explain how the surgery will make you walk differently.
If they don't discuss the risks-don't do the surgery there
If you need to travel to find the right doctor-go ahead.
The AnkleNFootCenters.com of Chicago are within 30 minutes from both airports.
We are specialists in posterior tibial tendon dysfunction problems and foot & ankle surgeries
Hope this helps!

Good Luck!    

Dr George Tsatsos & Svetlana Zats
Podiatrist Chicago 60618 & Elmhurst 60126 Podiatrists
Board Certified in Foot and Ankle Surgery & Orthopedics
New South Loop Location-Chicago 60661
AnkleNFoot.com
Runnersdoc.com
BabyFootDoc.com

DISCLAIMER:
This information is offered as free advice and as general information. It may not be applicable to the specific questioner and his/her problem.  It is not based on actual knowledge of the questioner or his/her medical history and it cannot and should not be relied upon as definitive medical opinion or advice.  Reliable medical opinion and advice can only be obtained through hands-on physical contact and exam of the patient to establish an accurate diagnosis and treatment plan.  No doctor/patient relationship is created or established here and may not be inferred through answers on this site.  The questioner and other readers must consult his/her own doctor before proceeding or implementing any suggestions contained within this document and answers on this site.  The questioner is only to act upon his/her own doctor抯 orders and recommendations. By reading this posting which follows, the reader fully understands and confirms that he/she holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are advised to read no further.
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Dr George Tsatsos & Svetlana Zats
Podiatrist Chicago 60618 & Elmhurst 60126 Podiatrists
Board Certified in Foot and Ankle Surgery & Orthopedics
New South Loop Location-Chicago 60661
AnkleNFoot.com
Runnersdoc.com
BabyFootDoc.com

DISCLAIMER:
This information is offered as free advice and as general information. It may not be applicable to the specific questioner and his/her problem.  It is not based on actual knowledge of the questioner or his/her medical history and it cannot and should not be relied upon as definitive medical opinion or advice.  Reliable medical opinion and advice can only be obtained through hands-on physical contact and exam of the patient to establish an accurate diagnosis and treatment plan.  No doctor/patient relationship is created or established here and may not be inferred through answers on this site.  The questioner and other readers must consult his/her own doctor before proceeding or implementing any suggestions contained within this document and answers on this site.  The questioner is only to act upon his/her own doctor抯 orders and recommendations. By reading this posting which follows, the reader fully understands and confirms that he/she holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are advised to read no further.