Causes and Resolution of Heel Pain

Heel Pain is one of the most common conditions Podiatrists see on a daily basis. Heel pain, also called Plantar Fasciitis and can be a very debilitating condition especially as time goes on left untreated.

CAUSES:

The plantar fascial band of tissue through long term micro-trauma leads to the tissue pulling away from the heel and causing a gap which the body begins to lay down bone and a heel spur forms. Heel spurs do not hurt, they are not at the level of a joint where they are being impacted upon. More importantly, when the tissue pulls away from the heel it is tearing the blood vessels that are feeding the tissue and the process of calcification (drying of the tissue) begins causing the tissue to harden and lose its flexibility. In other words the plantar fascia which is your foots shock absorber is beginning to rust. When the rust pocket gets big enough it places pressure on the nerve that runs beneath the heel and causes pain. Symptoms most commonly include pain in the heels when first rising in the morning. Some people will experience discomfort after periods of standing on their feet especially if they work on hard surfaces such as concrete all day. This pain can cause people to be unable to sleep at night.

DIAGNOSIS:

Diagnosis is made by palpating the bottom and the inside aspect of the heel and eliciting pain along the nerve. X-rays are taken to check the alignment of the foot and the size of the heel spur if present. Next, diagnostic ultrasound is used to measure the thickness of the plantar fascial band of tissue and the color. The normal band of tissue is less than 4mm in thickness and has a light color indicating good blood flow. Damaged tissue is thicker and darker indicating traumatic disruption of the foots shock absorber.

TREATMENT:

Conservative treatment is effective in resolving heel pain in 80% of the population. This consists of steroid injections, cushioned insoles, arch supports, padding, stretching and pain creams. Physical therapy consisting of radial shock wave which is low intensity therapy can be effective in reducing your symptoms if performed 1-2 x week x 5 or more weeks. There are viable alternatives especially if you have been experiencing heel pain for greater than 6 months. Most physicians are trained to do a surgical procedure called an endoscopic plantar fasciotomy (EPF) if the conservative treatment is unsuccessful. This procedure consists of an in-hospital procedure under anesthesia and will require 4-8 weeks off work if you have a job where you are on your feet all day.

When considering your options for treating heel pain after conservative therapy has been tried to no avail, think about this. You wouldn’t go out to your car and remove a shock absorber and drive around with only 3, would you? Then why would you do that to your foot? The EPF procedure releases your plantar fascia, which is your foots shock absorber. You are changing the structure and function of the foot and muscles which will lead to other conditions over time such as knee, hip and back pain.

High intensity shock wave is the safest and most effective treatment for the resolution of heel pain. One treatment performed in the office while you are awake. With high intensity shock wave the hardening of the tissue is broken apart through high pressure ultrasonic waves which increases the flexibility of the tissue and leads to an increase in the blood flow thereby healing the tissues. You are wearing you shoes the same day and back to work in a couple of days instead of weeks or months. One final analogy would be a bridge that has four connecting points and one of these points will be released to take the pressure off the nerve. Would you still drive your car over that bridge? That’s EPF. The physicians at Mid-Ohio Foot and Ankle have been performing high intensity shock wave for the last 20 years with a greater than 90% success rate with only one in-office treatment. midohiofootandankle.com