Foot Pain in Heel Bone
- Foot pain in the heel bone can be usually due to the development of a heel spur.
- A heel spur should essentially be treated as if though it were plantar fasciitis.
- –Plantar fasciitis is the most common cause of heel pain seen by foot and ankle surgeons.
- -Massive pain that inhibits you from standing
- -About 15% of the population suffer from plantar fasciitis.
- -This is usually an overuse injury at the origin of the plantar fascia caused by excessive stress to the foot or biomechanical abnormalities of the foot.
- -The plantar fascia stretches from your heel (calcaneus) to the joints of all your toes (Metatarsal phalangeal joints)
- -The plantar fascia consists of 3 bands: medial, central, and lateral.
- -Usually the medial band is damaged, but it can also be the central band.
- -The plantar fascial bands are supplied by the medial and lateral plantar nerves.
- -The thickness of a normal plantar fascia is approximately 3 mm.
- -In patients with plantar fasciitis, the maximum thickness is significantly increased to 7 mm
- -Plantar fasciitis is described as a painful inflammatory process.
- -generally at the origin of the plantar fascia on the calcaneus.
- -It can also be central in the plantar arch.
- **It is very uncommon for plantar fascia pain to be on the outside of your foot or toward the toes.
- -40 to 60 years
- -more common in women
- -High Arch and Flat Foot
- -Occupations that require standing
- -Common in athletes, nurses, mailmen, factory workers, mechanics etc
- -People with footwear that is loose & has no arch support.
- -Obese patients -this leads to chronic stretching & degeneration & pain.
- -Pregnant patients- the ligaments get loose and stretch
- -Tight Calf muscles
- -Pain is usually localized to the medial calcaneal tubercle
- -Initially pain is sharp and worse with the first step of the day after a period of non–weight bearing.
- -Chronically it is dull and painful over time
- Radiographs(X-rays) – Check for a Heel Spur- this is bone formation at the insertion of the plantar fascia- Note: this is not what causes the pain- but correlates the diagnosis
- Ultrasounds- Inflammed fascia is normally hypoechoic- but normal fascia is normally iso-echoic
- MRI- The best method- but almost never needed (highly overkill)
Low Dye Strapping
- I love this type of taping- it holds the foot in an ideal structure and re-inforces the arch for a couple days until the inflammation of the fascia can die down.
- Tip 1: ***If low dye taping does work for you- In my experience an orthotic will complete cure your heel pain the majority of the time***
Get the right shoes
- Tip 1: ***Get atleast a 1 inch heel on your running shoe – according to the Podiatric Sports Association***
- Tip 2: ***Make sure the shoe bends in the front and not in the middle or the back of the shoe**
- Tip 3: ***Avoid sandals & going barefoot on hard surfaces**
Stretching of the Achilles Tendon and Plantar Fascia
- Tip 1:***Studies show that stretching your achilles tendon 3x per day for 2mins at a time will cure the pain in 25% of
- Tip 2:**Stretching your feet(the plantar fascia) as well as the Achilles tendon boosts that number from 22% to 55%
- according to studies!*** So start stretching immediately!
- Tip 3:***Use night splints to stretch your feet for you while you sleep!***
- Wear these at night to keep your feet stretched (the toes point straight rather than down when you sleep)
- Tip 1: ***Studies show that night splints helped almost 100% of patients***
- Tip 2: ***Ease into them while napping, you forget you are even wearing them after 1-2 naps!***
- Studies show good relief after 2-4 weeks when combined with anti-inflammatory medications & ice.
- Ultrasound & whirlpool therapy also helps greatly.
- No exact numbers available from studies.
- Take a 2 week regimen of regular advil, Ibuprofen or any other NSAID(see pharmacist for dosing).
- Watch for allergies.
- Topical NSAIDS are frequently helpful- but no exact numbers are available from studies.
Injection of Corticosteroids:
In my experience- **this is the gold standard for immediate relief!** Fixed with a 5 minute visit to the podiatrist.
- Tip 1:***Studies show almost all people recieve temporary relief that last for up to 6-8 weeks, in about 25% it never comes back***
- Tip 2: If you remove the cause during the pain-free injection period(6-8weeks) then the pain should never come back.
***The long term Gold Standard- whereas corticosteroids are the short term gold standard***
- Tip 1: ***Orthotics combined with anti-inflammatories & Injections have an 85% permanent cure rate for plantar fasciitis! Compared to just 30% without orthotics***
- Tip 2: Get some arch supporting orthotics like PowerStep (25$) not the gel inserts of Dr. Scholl – they just cushion but not support the arch.
- Tip 3: Get some heel lifts if you can over Dr. Scholl, but PowerSteps are better than both.
- Tip 4: Powersteps > Heel Lift > Dr. Scholl Gel inserts
Extracorporeal Shock-Wave Therapy
Sound waves are propagated to damaged tissues to induce microtrauma.This microtrauma stimulates healing by attracting blood vessels and nutrients to the plantar fascia.
- Tip 1:*** Used as a last ditch effort before surgery if you are rich- because it is not covered by any insurance***
- Tip 2: I say avoid it- its expensive and unproven!
Studies show that only 5-10% of people will ever need surgery on their Heel for Plantar Fasciitis.
Open Plantar Fasciotomy
- -Open plantar fasciotomy allows for release of the tight plantar fascial bands.
- -Studies show that this surgery is 37% effective with a fascial release only & 45% successful in curing with fascial release as well as removal of the bone spur.
- -Most do experience relief-
Endoscopic Plantar Fasciotomy ***Great choice***
- -Popular due to minimally invasive nature.
- -Minimizes complications and recovery time compared with open procedures.
- -A scope is inserted through a very small incision and the fascia is resected.
- -Satisfaction ranged from 60% to 80% with this procedure in relief of heel pain.
- -Percutaneous cryosurgery uses subfreezing temperatures to produce analgesic effects.
- -Nerves are detected & frozen for 3 mins, then thaw for 30 seconds & repeated.
- -Numbness will occur for many months.
- -Research shows 78% success – but more research is still needed for this procedure.
Radiofrequency Nerve Ablation
- -Another minimally invasive procedure that ablates the nerve with an electrode through the skin.
- -Patients are allowed to bear weight immediately after the procedure.
- -Coblation therapy with Topaz is a form of bipolar radiofrequency.
- -causes microscopic damage to the fascia, which increases the blood supply to the fascia; this causes it to rebuild and flood the area with growth factors.
- -Patient shouldn’t walk for 3 weeks.