MY HEEL HURTS
By now you have probably already diagnosed yourself with Plantar fasciitis as you have goggled heel pain. Like many people that come into the office, they will tell me that their heel pain is worse after they have been sitting and once they have taken a couple of steps it will improve.Plantar fasciitis is sometimes known as a "heel spur". The term commonly used to refer to heel and arch pain is traced to an inflammation on the bottom of the foot. More specifically, plantar fasciitis is an inflammation of the connective tissue, called plantar fascia, that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Overpronation is the most common cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Generally it is considered an overuse injury and over time, this causes inflammation. People will ask me if their weight influences their heel pain. It may if you are overweight and a decrease in approximately 10lbs can be helpful.
Generally we will take x-rays to determine if there is a spur and to check for fractures and tumors that can occur in the heel bone. We are also able to measure the amount of inflammation a patient has with an ultrasound and monitor it over time. There can be times when the planatar fascia will actually rupture and will need to be treated appropriately.
Things you can try first is stretching and most people will have already tried OTC inserts. The problem with them is that if your heel pain does not go away is that it does not brace your foot enough to help with the uncontrolled overstretching that is occuring. A true custom orthotic that properly supports and braces your arch is the mainstay of treatment. It is imperative that you also perform proper controlled stretching exercises. As with any inflammatory condition one can also use of anti-inflammatory medications and ice packs. Often times Physical therapy is also helpful. There are times when your pain is so great that in order to calm things down a steroid injection is necessary.
So what if you have done all these things and you are not better. You may need to allow the foot to rest and decrease your activity with immobilization. Well doc, I have done that, now what. There are times when your heel pain needs to be addressed with surgery and depending on how your pain presents to your doctor you may need to have an open release along with lengthening your gastroc (heel cord area). Sometimes there is a nerve that also gets entrapped and we will look for that. There can be an alternative to the open release and that may be the use of Topaz and PRP. What does that mean you may ask. It essentially works at trying to convert your chronic inflammation to acute to get the body to heal itself. It is done through tiny holes about the size of a large needle and a wand is introduced that stimulates the fascia. PRP or platelet rich plasma is take from your own blood and the good things ie platelet is injected back into your heel to help the process along. It is up to your doctor to make the plan that is right for you depending on what is going on with your feet because often times more than than one thing may influence your treatment protocol. Here is to your feet, may they carry you through the rest of your days.