Avon Podiatry Forms

Plantar Fasciitis and Heel Pain

Heel Pain: Plantar Fasciitis and Heel Spurs: Heel pain is one of the most common and debilitating pains in the foot. It also is one of the most common of complaints in a podiatric office. Heel pain is directly related to the plantar fascia, and not to the presence of a heel spur. The plantar fascia is a ligament-like tissue on the bottom (plantar surface) of the heel that runs from the heel bone (calcaneous or os calcis) out to the ball of the foot and on to the toes.

Reasons for heel pain: With each step, the arch normally flattens a bit. In some people it flattens more than it should. As the arch flattens, the foot gets longer and the plantar fascia tightens and stretches. When the arch flattens more than normal, or in a foot where the plantar fascia will no longer stretch to accommodate the lengthening of the arch, the fascia over tightens. Microscopic tears begin to form where the fascia attaches to the heel bone. These tears become inflamed, and pain results. There are other reasons for a plantar fasciitis, but this is by far the most common. Often a heel spur is seen on X-ray or Ultrasound examination, but the spur is incidental to the plantar fasciitis and is not at all related to any pain the sufferer might have.

Although a weigh problem alone, within reason, does not cause plantar fasciitis, it adds to and compounds the problem. With each step, your heel instantaneously hits the ground with approximately 3 times body weight. You probably take near 10,000 steps a day. You can easily see how extra body weight can make your heel pain worse.

Patterns of pain in plantar fasciitis: Although there are many patterns of pain in a plantar fasciitis or heel spur syndrome, the most common are post-static dyskinesia, or pain after rest. Typically the heel will hurt in the morning after arising from bed. The first few steps may be very severely painful. This pain will usually lessen and work out with a few steps or after a hot shower, only to have the pain return as the person walks and bears weight throughout the day. After rest, or a short period of sitting, the pattern repeats. If the right foot is involved, this pain may also be reported to be severe while driving a car.

Treatments:
Plantar fasciitis can be one of the most rewarding podiatric problems to treat with a higher than 90 percent success rate without surgery. The remaining few cases may require what is called Extra-Corporeal Shock Wave Therapy or, for short, ESWT. Some few cases will need surgery.

Various Treatment Regimens:

Stretching: Any activity that stretches the calf muscles will also stretch the plantar fascia. These exercises should be done twice a day. The stretch should be held for 10 seconds, and repeated for 10 repetitions. Do at least one of the exercises twice a day.

One method of stretching is to lean into the wall - wall push-ups. Place your painful foot to the rear (or both if necessary), your good foot in front, toes pointed straight ahead, and lean into the wall. The Pro-stretch device you can order from the link provided is a very convenient device to encourage stretching. You can see other stretching techniques here & here.

In the morning, before getting out of bed, try stretching by painting the alphabet with your toes and pulling your toes up towards your shin. This may lessen the first-step pain called post-static dyskinesia, in many cases. Night splints that you wear while asleep may also be helpful - these can be provided in the office. Stretching should remain a daily activity, twice a day, throughout life, as is brushing your teeth. It only takes a few moments, and can pay big dividends.

Anti-inflammatory Medications: Over the counter anti-inflammatory medications are often used. In the office, I will often prescribe anti-inflammatory medications. At times, cortisone injections are also helpful.

Cushions: in a few certain foot types, in addition to the anti-inflammatory medications, a visco-elastic heel cushion or a heel cup can be helpful.

Orthotics: Orthotics are custom made from a plaster cast or from impressions of your feet. They are prescription arch supports and control excessive foot motion. The orthotics will also redistribute the weight bearing forces throughout the foot as it strikes the ground. They fit most sensible shoes. These are often the mainstay of treatment. Statistically, they have the highest success rate of all the treatments. Orthotics are often partially covered by your insurance company. My office will check with your insurance for you prior to your appointment for the devices.

Weight: Keeping your weight as near normal as possible can be a big help in preventing or lessening heel pain. For a split second, with each step, your heel will carry approximately 3 times your body weight. Over the course of a day, when you add that up, that can be several tons of extra pressure on a sore heel for each pound overweight you might be.

Surgery: Heel surgery is always held until last. On occasion, the spur is removed if present, but many times not, since the spur is not the true cause of the pain. In all cases, the plantar fascia is cut in part or whole, from its origin at the bottom of the heel bone. The fascia heals by scar tissue, but it is now longer than before surgery and acts as if it has been stretched. This surgery, and all its variations, including the newer endoscopic surgery, can take a protracted time for complete healing and does not always completely relieve the pain. Like all surgery, this is best avoided if possible.

High Energy Sound (shock wave) wave treatment. This is extra corporeal shock wave therapy (ESWT) wherein a high-energy shock wave is aimed at the inflamed tissue. This requires local anesthesia and is done in the office. The patient can be expected to miss only one or two days of work, but high impact activity and anti-inflammatory medications must be avoided for 6 weeks after the procedure is done. The full effects of ESWT are not seen for about 6 months after the procedure is performed and even more reduction in pain may be noticed for upwards of 1 year. As ESWT is not covered by insurances, payment arrangements are made in the office and the procedure is only used after care has been taken and before surgery is offered.

Doctor Gurvis was one of the very first to perform this procedure in Indianapolis and has now done over 150 of these procedures. The success rate for ESWT approaches 80%.

Ask Doctor Gurvis if this procedure is appropriate for your case if you are suffering from plantar fasciitis, and have not obtained sufficient relief with conservative care. If you are coming from a distance, you can have your records forwarded to Dr. Gurvis for review to see if your case might respond to Shock Wave Therapy prior to coming in for an appointment. There is no fee for this review.

David E. Gurvis, D.P.M. of Avon Podiatry
Hendricks Regional Health Care Avon Campus
8244 E. US Highway 36, suite 120
Avon, Indiana 46123

317-272-0556

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