One of the most common complaints in our office is that of heel pain. In excess of ninety percent of heel pain complaints are diagnosed as having inflammation of the plantar fascia (a ligament on the bottom of the foot). Commonly referred to as a heel spur or stone bruise, plantar fasciitis (plantar fashitis) can be a severely debilitating and painful condition.
Frequently described as a deep burning ache, the pain is most commonly experienced early in the morning when first placing the feet on the ground, and also following a short period of rest, for example, when getting up to walk after watching television for an hour or two.
What causes the pain is any one or combination of things. A change in shoe gear, an increase in physical activity, lack of adequate support in shoes, frequently walking barefoot, an increase in weight, or simply a naturally flexible foot type all contribute to the development of plantar fasciitis.
The plantar fascia is a fibrous, broad band of tissue that attaches from the heel bone (calcaneus) and fans out to attach to the heads of the metatarsal, (balls of the toes). The function of the plantar fascia is to provide stability and prevent the arch from flattening. The foot pronates, or flattens, to absorb shock from the ground, however, in some instances, this motion can cause the plantar fascia to pull on the heel bone, causing small micro-tears from the bone, resulting in severe inflammation and pain. When sitting or sleeping the body attempts to heal the area, which includes a process of inflammation involving contracture of the inflamed tissue. Unfortunately, eight hours of sleep is not sufficient to heal the inflammation, and the patient walks causing persistent pulling of the plantar fascia on the heel bone. This revolving circle of inflammation and pain continues until successful treatment is achieved.
Treatment is directed at minimizing the pull and tension of the plantar fascia with standing and walking. Treatment must involve mechanical support of the arch to reduce the tension and strain of the plantar fascia, AND reduction of the inflammation of the fascia attachment at the heel bone. Simply prescribing anti-inflammatory medication without addressing the mechanical factors may temporarily relieve the pain, but seldom achieves long term resolution.
Patients frequently attribute the development of a heel spur as the cause of their pain. Development of a heel spur is a reflection of the duration of the pulling of the plantar fascia on the heel bone. Although it may feel like it at times, there is no bone spur sticking "down" from the bottom of the heel. The heel spur is not the cause of the pain, but is the result of the inflammation. Finally, presence of a heel spur does NOT mean this needs to be surgically removed.
Treatment of plantar fasciitis is directed at minimizing the pulling and strain of the plantar fascia. Treatment must be direct at reducing the strain of the plantar fascia by way of an arch support (shoe insert). Treatment options include taping, padding, arch supports, night splints, steroid injection, anti-inflammatory medication, physical therapy, stretching exercises, activity modifications, avoidance of bare feet, rest, shock wave therapy, platelet rich plasma injection, and surgery. Along with a short course of anti-inflammatory medication (Advil, Motrin, Aleve, Naprosyn), a good, sturdy arch support, preferably one custom molded to the foot (orthotic) is an absolute necessity for resolution of plantar fasciitis.
On average 97% of heel pain patients achieve relief without surgery. For those who are unable to attain relief with several weeks of conservative treatment, surgery may be a viable option.
Should several weeks of conservative treatment fail to alleviate the severe heel pain, other treatments may be required. The plantar fascia anatomically does not possess much blood supply. When an area of the body without much natural blood flow develops a chronic inflammatory condition, there is no more added blood supply provided to the tissue than what is there naturally. By contrast, if a person twists an ankle, there is typically bruising involved. The bruising develops as a result of torn vessels in the tissue, creating an acute inflammatory response. This results in increased blood flow to the area, allowing the tissue to heal. However, when a chronic inflammation develops in a tissue without much natural blood flo, no added blood flow is provided to the area. As a result, when the inflammation of the plantar fascia fails to respond to conservative treatments, it is usually the result of scarring or fibrosing of the fascia. In a small portion of fasciitis patients, conservative treatments do not provide much relief, and other treatments must be employed to resolve the condition.
Treatment in this scenario involves causing a mild acute inflammation of the plantar fascia to allow the body to heal itself. This is accomplished in the office with a hand held extra corporeal shock wave treatment (ESWT), which provides hundreds of sound waves directed at the plantar fascia to allow the area to heal. This does not require anesthesia (needles) and can be performed in the office. Up to four ESWT treatments may be required.
If there is no resolution of the symptoms following ESWT, a platelet rich plasma injection (PRP) can be performed. This involves anesthetizing the heel in the office, and withdrawing 20cc of blood from the arm. The blood is spun in a centrifuge, and a small layer of the platelets pulled from the blood, and injected into the inflamed tissue. The success rate of this treatment is over 80%, and is covered by most all insurance companies.
For more information on treatment of your heel pain problems, please give us a call!
Understand, use of an arch support or orthotic alone is not usually effective nor adequate in treating plantar fasciitis. It is my opinion that arch supports are NOT a treatment, but simply maintenance to prevent digression of the condition. If your heel pain does not improve with conservative treatment, you could have PLANTAR FASCIOSIS. For more information, click here http://bluegrassfootcenters.com/what-we-treat/41-what-we-treat/100-platelet-rich-plasma-injection-prp.html
If you suffer from foot pain, give us a call at 270-684-5252. Treatment options are available!
Dr Block is an excellent podiatrist. The staff is friendly and very professional.