There are many painful problems of the foot or ankle that people live with on a day-to-day basis. Many are not aware of easily provided medical solutions which are covered under their health insurance policies. Problems such as heel pain; This person wakes up in the morning steps down and all of a sudden there is an aggravating aching pain in the heel of their foot. Usually after limping around for a while the intensity of their discomfort seems to decrease becoming more tolerable. Yet some degree of pain remains. The day progresses and soon arrives lunch. They sit down eat their lunch taking up the usual half hour to hour break, get up to begin the afternoon shift and ouch! There it is again, that same intense aggravating pain they woke up with.
This is a very common scenario. Many people refer to this as a heel spur, although more accurately referred to as plantar fasciitis. On the bottom of the foot is a tendon like band of soft tissue called the plantar fascia. This attaches to a very localized spot at the heel bone. It fans out and inserts through out the ball of the foot. The plantar fascia is only so long and can stretch so far and when it pulls at the heel inflammation and pain results. This problem is more commonly seen in people with flat feet or extremely high arches.
When the foot steps down it generally flattens out from the weight of the body. When this occurs excessively the plantar fascia stretches more than it can tolerate. The average person takes 10,000 steps a day. As the attachment to the heel bone is repeatedly stretched past its comfortable length, a pain cycle begins. Fibers are torn, the bone becomes irritated and inflammation sets in. In time eventually spurs result. When your feet are at rest such as when sleeping or a lunch break, the plantar fascia contracts and tightens up. The actual length decreases so that when you suddenly get up and step down the pulling at the heel bone is much greater and the pain more severe. Eventually this stretches and relaxes and the pain decreases but never seems to totally go away. The actual pain comes from the chronic inflammation of the fascia at the attachment to the heel and not the spurs. So you can have heel spur pain without actually having spurs.
Most people don't realize that plantar fasciitis can easily be treated. Conservative treatment focuses on mechanically resting the fascia and stopping the cyclic tearing and pulling of fibers. This is combined with the prescription of oral anti-inflammatory medication. The main goal is to support the arch so as to control flattening of the feet and quiet down the inflammation associated with it. Strapping and padding of the sole of the foot is a most effective way to support the fascia. This is easily done at the podiatrists office. Should this be successful, the prescription of custom orthotics can help to permanently support the natural arch thus prevent recurrence of heel pain. These devices are specific to each individual foot type.
Often if heel pain has gone on untreated for many months simple mechanical support and oral medications become ineffective. At this stage the podiatrist may require an injection of cortisone into the inflamed fascia. Cortisone serves as a potent anti-inflammatory medication working locally at the spot at which it is injected. More often than not one injection combined with strapping and padding can cure the symptoms completely. If not, a series of three injections usually solves the problem combined with biomechanical control.
When conservative treatment has failed, technology offers hope. Extracorporeal Shockwave Therapy (ESWT) is a non invasive treatment where repetitive shockwaves are used to interrupt the chronic inflammatory process and create an acute injury response which stimulates a process called neovascularization. With proper post-treatment care many can avoid the inevitable surgery.
In very rare circumstances some heel pain fails to respond to conservative treatment. These cases go on to surgical intervention. Traditionally this involved the surgical release of the plantar fascia from its attachment to the heel bone with or without the removal of the existing heel spur. This is performed through a conventional incision and required 3 - 4 weeks of convalescence. If surgery does become the answer, there now exists endoscopic surgical techniques in which heel spur surgery is performed through very tiny incisions with the use of a small camera lens and a television monitor. These people can be walking again with out pain within 3 - 7 days. However, conventional surgery continues to be the most effective non conservative approach.
Not everybody responds to treatment in the same way, and each person is treated according to their own individual needs and complaints. So if you find your limping out of bed in the mornings, and your heels ache through out the course of the day; Now you know. Help is just around the corner. Go get it.
Jonathan Pattavina DPM of the
Advanced Foot and Ankle Specialists
practices in Keene and Peterborough, NH.
