WHEN YOUR HEEL PAIN JUST WON'T GO AWAY

There are times when traditional conservative treatments such as ice, rest, padding, taping, anti-inflammatory medications, steroid injections, physical therapy, shoe inserts, night splints, immobilization, and shoe and/or activity modifications simply don't work.  When the pain is either on the bottom or back of the heel, this can be the result of a chronic inflammatory condition developing in an area that naturally, anatomically does not possess much blood flow.  Both the plantar fascia attachment to the heel bone, and the achilles insertion in the back of the heel both possess little circulation.  When inflammation develops slowly (chronically), there is no additional bleeding in the tissue than what is there normally.  In contrast, if you were to sprain your ankle on the curb, you would see, among other things, bruising.  The bruising is the result of torn blood vessels, and are part of the acute inflammatory response.  The bleeding in the area is what allows this area to heal over the course of a few weeks.  With either chronic inflammation unresponsive to conservative treatments of the achilles tendon (called achilles tendonosis) or the plantar fascia (plantar fasciosis) the tissue in this area is very dense, hard, and fibrous. 

For the past 40-50 years, the phenomenon has been known, and the philosophy of treating this has not changed in that time.  The WAY this is accomplished has changed and evolved.  The GOAL of treatment is to create a controlled acute inflammation in the tissue to allow the body to HEAL ITSELF.  Years ago, the heel was anesthetized with an anesthetic, and a large bore needle was used to penetrate the bottom of the heel several dozen times to create this inflammatory response.  More recently, this can be accomplished with either Extracorporeal Shockwave Therapy (ESWT) which involves directing sound waves at the tissue to create the acute inflammation, as well as with Platelet Rich Plasma (PRP) injection.  PRP involves drawing 20cc of blood from the arm, spinning the blood down in a centrifuge, and isolating the platelets.  The platelets contain the growth factors within blood.  The area to receive the PRP injection is initially anesthetized, then using an ultrasound machine for visualization, the tissue is injected several dozen times and finally the platelet mixture injected in to the tissue.  All anti-inflammatory medications are discontinued, as an acute inflammation is purposely created to allow the body to heal itself.  Anti-inflammatory medications will only suppress this response.  There is typically not much more pain than before this procedure, yet a short leg walking cast must be worn for 4 weeks to immobilize the area and allow this to heal.  My experience with PRP is very good at alleviating resistant, chornic plantar fasciitis and/or achilles tendonitis, with a success rate of 80-85%.  Call us if you would like to discuss Platelet Rich Plasma injection therapy.

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