I see Phil at out of state marathons. He continues to tough out his heel pain. Others I’ve met gave up running or had surgery, and multiple cortisone shots. A new non-invasive “EPAT” ultrasound procedure is now available in the office.
Heel pain is one of the more common injuries we see. Many an everyday runner or weekend warrior at middle age can develop this nagging recurring pain. They don’t get the attention the elite or professional athletes receive. The pain typically comes when getting out of bed or a chair. The direct cause is usually a tight ligament in the arch, a tight Achilles cord or both causing a micro-tearing and inflammation. So we work at stretching the related calve and foot muscles and calming down the inflammation. The inflammation has to be reversed. Rest, ice, and stretching are used if the pain is recent, recent in terms of days or weeks.
More often, I see a patient like Phil, who has had the pain for several months. He blames it on a bruise, but runs anyhow and expects it to go away in couple of months. At this point, the scarring from the micro-tears thickens the ligament (plantar fasciitis) or tendon (Achilles tendinitis). The “tendinitis” digresses to a chronic “tendinosis”.
The thickness of the fascia or tendon is appreciated with an ultrasound exam. Any spur or bone disease is also ruled out with an X-ray. Stretching and a night splint are used, depending on the degree of tightness. Ice therapy is recommended, along with gait analysis and training: “walking through the ball of the big toe”. Shoes, orthotics taping and the use of kinetic tapes are reviewed. If these methods only bring limited relief, a EPAT therapy is recommended. This involves the application of a low frequency shock wave ultrasound treatment. No local anesthetic is required as it was in the recent past. Moreover, the advanced technology makes it possible to do in the office. The procedure takes four minutes and requires about four treatments. Less than 10 per cent of our patients require surgery. So no one has to give up running or like Phil, put up with the pain.
Dr. Landry is a foot doctor practicing podiatry in Overland Park, KS – which is near Shawnee Mission, Lenexa, and Olathe KS. Dr. Landry believes an ounce of prevention is better than a pound of cure. If you are suffering from foot heel pain, don’t wait until the symptoms get worse… call Dr. Landry today for a full foot & heel examination. Dr. Landry is also a board certified foot surgeon and marathon runner.
Heel pain is a stressful condition that effects day to day activities. Running and walking causes stress on the heel because the heel is the part of the foot that hits the ground first. This means that the heel is taking on your entire weight. Diagnosis and treatments for heel pain can be easily found through your podiatrist.
One of the main causes of heel pain is a condition known as plantar fasciitis. The plantar fascia is a band of tissue that extends along the bottom of the foot, from the toe to the bottom of the heel. A rip or tear in this ligament can cause inflammation of these tissues, resulting in heel pain. People who do not wear proper fitting shoes are often at risk of developing problems such as plantar fasciitis. Unnecessary stress from ill fitting shoes, weight change, excessive running, and wearing non-supportive shoes on hard surfaces are all causes of plantar fasciitis.
Achilles tendonitis is another cause of heel pain. Similar to plantar fasciitis, inflammation of the Achilles tendon will cause heel pain due to stress fractures and muscle tearing. A lack of flexibility of the ankle and heel is an indicator of Achilles tendonitis. If left untreated, this condition can lead to plantar fasciitis and cause even more pain on your heel.
A third cause of heel pain is a heel spur. A heel spur occurs when the tissues of the plantar fascia undergo a great deal of stress, leading to a separation of the ligament from the heel bone entirely. This results in a pointed fragment of bone on the ball of the foot, known as a heel spur.
Treatments for heel pain are easy and effective as long as problems are addressed quickly. The most common solution is simply taking stress off the feet, particularly off of the heel. This will ease the pain and allow the tendons and ligaments to relax. In the case of both plantar fasciitis and Achilles tendonitis, icing will reduce swelling of any part of the foot and anti-inflammatory medication is highly recommended. Properly fitting your shoes and wearing heel pads or comfort insoles will also reduce the risk of developing heel pain. Stretching before and after exercises such as running will help the foot muscles prepare for stress and lower the chances of inflammatory pain. In extreme cases, relieving heel pain might require surgery. Always make sure to discuss these symptoms and treatment options with your podiatrist to keep yourself active and pain free.
A new treatment option which combines ultrasound waves and steroid injections was found to be 95% effective in patients suffering from plantar fasciitis, according to a groundbreaking study from the University of Genoa in Italy.
The plantar fascia is a connective tissue in the heel that stretches the bottom length of your foot. Plantar fasciitis is the inflammation of this connective band, causing heel pain and overall discomfort while walking or standing. Although the condition is completely treatable, traditional methods can take up to a year to start being effective.
These conventional treatments include arch support, night splints, certain exercises, and overall rest and staying off your feet. The previous effective method for curing plantar fasciitis was shockwave therapy, in which sound waves are directed to the area where the pain is being experienced, often the heel. Despite the success of shockwave therapy, it could be considered somewhat painful, requires several sessions before any results are noticed, and is comparably expensive. However, even shockwave therapy does not cure the pain caused by plantar fasciitis in every patient.
The study, conducted by Luca M. Sconfienza, M.D., examined the effects of a new technique that combined ultrasound-guided methods, similar to shockwave therapy, with a steroid injection directly the plantar fascia. Because of the added steroid injection, the method becomes a one-time outpatient procedure involving a small amount of local anesthesia, in which a needle punctures the affected area and causes a small amount of bleeding that aids in the heeling of the fascia. This technique is referred to as dry-needling.
Dr. Sconfienza determined that 42 of the 44 patients involved in the new procedure had their symptoms, including pain, disappear entirely within three weeks. “This therapy is quicker, easier, less painful, and less expensive than shockwave therapy,” Dr. Sconfienza stated. “In cases of mild plantar fasciitis, patients should first try non-invasive solutions before any other treatments. But when pain becomes annoying and affects the activities of daily living, dry-needling with steroid injection is a viable option.”