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Heel Pain |
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Heel pain is one of the most common afflictions that affects the musculoskeletal system for Americans. It is estimated that 6 of 10 Americans will experience heel pain at some point in their lifetime. The medical term for heel pain syndrome is 'plantar fasciitis' and causes pain to the bottom or inside of the heel and usually comes on gradually but may also start rather suddenly. Although it more commonly affects active people, it also can affect sedentary people. Occupation can be a contributing cause with a higher incidence seen in people who work long hours standing or walking on concrete or hard surfaces.
The foot is an architectural wonder and contains numerous bones, ligaments, muscles, and tendons that work together to allow humans to walk comfortably. The foot undergoes a high amount of daily stress.
Frequently, the heel takes the brunt of this stress and is afflicted with this condition called plantar fasciitis. However, not all heel pain is caused by plantar fasciitis so it is important to see a podiatrist (foot and ankle specialist) so the cause can be determined and the pain resolved. Most U.S. podiatrists see plantar fasciitis patients every day in their offices and are very good at diagnosing and treating this painful condition.
The plantar fascia is a very strong 'ligamentous-like' band of tissue in the sole of the foot that functions to support the heel and arch of the foot. When this fascia becomes fatigued, strained or over-stretched, it can cause sharp pain to the heel. The pain is usually the worst when arising in the morning and taking the first few steps out of bed. It is also painful after a period of sitting or resting. It usually subsides a little during the morning hours but often returns in the afternoon hours when our feet start getting tired. Pain can be sharp, achy, or burning in nature. However, in most cases redness and swelling are not visible. Plantar fasciitis is primarily experienced by adults of all ages and activity levels. It is not seen in children and if a child experiences heel pain it is very important for the child to be seen quickly to make sure there are no growth plate disturbances or other important problems that can arise in children.
Diagnosis of plantar fasciitis should be done by a health care professional. Frequently, adults attempt to self-diagnose or allow a friend to do so not realizing that there are many other causes of heel pain. Examples are tarsal tunnel syndrome, nerve entrapment, stress fracture, bursitis to the heel and more.
Dr. Still always performs a thorough exam for all patients experiencing heel pain. Sometimes, in more severe or chronic cases Dr. Still will utilize musculoskeletal ultrasound in the office to aid diagnosis and gauge the severity of the problem. A sonogram of the heel and arch helps Dr. Still and the patient get a visual picture of the problem area. At Still Foot and Ankle Care plantar fasciitis is always treated first with conservative modalities. Frequently, supportive taping, arch supports, stretching, icing, anti-inflammatory medications and injections are used to resolve this painful condition in a few visits. Dr. Still emphasizes that good shoes can aid this problem resolve more quickly. In addition, the patient must take an active role in their care and perform the recommended stretching, icing, rest or activity modification as directed.
Heel pads or cheap over the counter arch supports are usually not very effective. The importance of quality shoes cannot be over emphasized (see shoe page on this website). Look for shoes with a removable insole so that there may be room to add an insert or arch support. Arch supports or orthotics help stabilize and re-align the foot to reduce stress to the heel and arch and help plantar fasciitis resolve.
Dr. Still takes pride in the fact that a very small percentage of his patients require surgery for plantar fasciitis. In most cases conservative treatment solves it. Other treatment options include surgery, shock-wave therapy and platelet rich plasma injections (PRP). Surgery involves a minimally invasive procedure called endoscopic plantar fasciotomy and success rates approcah 85-90%. Dr. Still is also trained in a treatment for chronic heel pain called 'extra-corporeal shock wave therapy' (a.k.a. 'shock wave treatment'). This is a non-surgical treatment for chronic heel pain that has failed the usual treatments mentioned above. Unfortunately, this treatment option is often not covered by insurance and recently we have not been able to provide this option due to cost to the patient. Dr. Still also can perform a "PRP injection". This is known as a platelet rich plasma injection and is a fairly new treatment option for severe heel pain that has not responded to normal treatment methods. Unfortunatley, this treatment currently is not covered by insurance due to pending FDA approval for use the heel (it is considered off-label use). It often is covered in the elbow. Dr. Still can provide this in the office for a cost of $400.00
Plantar fasciitis can be a frustrating condition for a patient. There are many treatment options available but it is important to remember that there is not one treatment that always works. Dr. Still has excellent treatment plans to help you resolve of your heel pain.
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