Episode 180: Dr. Arianna Gianakos – Plantar Fasciitis in Athletes (Part II)

🎧 Episode Summary

In Part II of our discussion on plantar fasciitis, Dr. Ashley Bassett and Dr. Catherine Logan continue their conversation with Dr. Arianna Gianakos, orthopedic foot and ankle surgeon at Yale University. This episode focuses on treatment options for patients who fail initial conservative management, including injection therapies, biologics, and surgical intervention for recalcitrant plantar fasciitis.

The discussion highlights the latest evidence supporting platelet-rich plasma (PRP), compares PRP to corticosteroid injections and other nonoperative treatments, and reviews emerging minimally invasive surgical techniques—including nano-arthroscopic plantar fascia release.

Highlights

Platelet-Rich Plasma (PRP) for Plantar Fasciitis

Recent evidence continues to support the use of PRP for chronic plantar fasciitis.

Key findings from a 2024 Level I systematic review and meta-analysis:

• PRP resulted in significantly greater pain reduction compared to:

  • Corticosteroid injections

  • Extracorporeal shockwave therapy (ESWT)

  • Placebo injections

• PRP demonstrated improved functional outcomes as measured by AOFAS scores.

• Benefits were most apparent in patients with chronic, recalcitrant symptoms.

PRP vs Corticosteroid Injections

Corticosteroid Injections

Advantages:

• Rapid short-term pain relief

• Widely available

• Low cost

Limitations:

• Effects are often temporary

• Higher recurrence rates

• Potential risks include:

  • Plantar fascia rupture

  • Fat pad atrophy

  • Tissue degeneration with repeated injections

PRP

Advantages:

• Targets the underlying degenerative process

• Encourages tissue healing and remodeling

• More durable symptom relief

• Improved long-term outcomes compared with corticosteroids

Challenges:

• Higher cost

• Lack of standardization in preparation techniques

• Variability in platelet concentration and leukocyte content

The Role of Biologics

A key theme throughout the discussion is that biologics should be viewed as tools to optimize healing rather than miracle cures.

Important considerations include:

• Appropriate patient selection

• Chronicity of symptoms

• Failure of structured conservative treatment

• Realistic expectations regarding recovery timelines

When Is Surgery Appropriate?

Fortunately, most patients improve without surgery.

Surgical intervention may be considered when:

• Symptoms persist for 6–12 months or longer

• Conservative treatments have been exhausted

• Pain continues to significantly limit daily activities, exercise, or athletic participation

Before surgery, patients should typically complete:

• Stretching and strengthening programs

• Orthotic management

• Night splints

• Physical therapy

• Injection-based treatments when appropriate

Nano-Arthroscopic Plantar Fascia Release

The episode concludes with a discussion of a novel nano-arthroscopic plantar fascia release technique recently described in Arthroscopy Techniques.

Potential advantages include:

• Single-portal minimally invasive approach

• Reduced soft tissue disruption

• Less postoperative pain

• Reduced neurovascular risk

• Earlier weightbearing

• Faster return to daily activities and sport

Surgical Pearls

When performing plantar fascia release:

• Partial release is preferred over complete release.

• Over-release can alter foot biomechanics and increase lateral column pain.

• Careful patient selection remains critical.

• Surgery should be reserved for truly recalcitrant cases.

Key Takeaways

• PRP demonstrates superior pain relief and functional outcomes compared to corticosteroid injections and placebo in chronic plantar fasciitis.

• Corticosteroids may provide short-term symptom relief but do not address the underlying degenerative pathology.

• Most patients improve with nonoperative management and never require surgery.

• Surgical treatment should be reserved for patients who fail a comprehensive course of conservative care.

• Nano-arthroscopic plantar fascia release represents an exciting minimally invasive option that may reduce pain, soft tissue injury, and recovery time.

• Appropriate patient selection and realistic expectations remain essential regardless of treatment choice.

Featured Guest

Dr. Arianna Gianakos – Orthopedic Foot & Ankle Surgeon, Yale University; specialist in sports-related foot and ankle injuries, cartilage restoration, and advanced foot and ankle reconstruction.

🎤 Stay Connected

🎧 Listen & Subscribe

If you enjoyed this episode, be sure to subscribe, rate, and review on:
Apple PodcastsSpotify

Follow us on Instagram

Our Hosts:

Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com 

Follow us on Instagram @thesportsdocspod for the latest updates in sports medicine, injury recovery, and athlete performance.