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Heel Pain

Heel Pain

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.

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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.

Plantar Fasciitis

 Recently, a groundbreaking study concluded that their treatment combining ultrasound with steroid injections was 95% effective in the treatment of plantar fasciitis.

Plantar fasciitis is a foot problem affecting the plantar fascia, a connective tissue in the heel. This condition is treatable, but in many cases can take up to a year to be effective.

Conventional treatments have included exercises, rest, arch supports, and night splints. If this proves to be inaffective, many patients undergo shockwave therapy. In shockwave therapy, sound waves are directed to the area where pain is experienced. This therapy can be affective, but is somewhat painful, and calls for several sessions. Even still, shockwave therapy does not always alleviate the pain caused by plantar fasciitis.

Luca M. Sconfienza, M.D., from the University of Genoa in Italy, conducted the study. The new treatment involves an ultrasound-guided technique with a steroid injection to the plantar fascia. It is a one time out patient procedure involving a small amount of anesthesia. Then an anesthetic needle punctures the affected area. This technique, known as dry needling, causes small amounts of bleeding that aid in healing the fesci.

It was discovered that 42 of the 44 patients involved in the study had their symptoms disappear entirely within three weeks. “This therapy is quicker, easier, less painful, and less expensive than shockwave therapy” Sconfienza stated. “In cases of mild plantar fasciitis, patients should first try noninvasive 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,” she added.

Heel Pain

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.

Sever’s Disease

Sever’s disease, also known as calcaneal apophysitis, is a medical condition that causes heel pain in one or both feet of children during the period when their feet are growing. Sever’s disease occurs most commonly in boys and girls between the ages of 8 and 14 years of age.

Sever’s disease occurs when the part of the child’s heel known as the growth plate, or the calcaneal epiphysis, an area attached to the Achilles tendon, suffers an injury or when the muscles and tendons of the growing foot do not keep pace with bone growth. The result is constant pain experienced at the back of the heel and the inability to put any weight on the heel, forcing the child to bear weight on their toes while walking. A toe gait develops in which the child must change the way they walk to avoid placing weight on the painful heel, a position that can lead to other developmental problems.

The most common symptom of Sever’s disease is acute pain felt in the heel when a child engages in physical activity such as walking, jumping or running. Children who are very active athletes are among the group most susceptible to experiencing Sever’s disease because of the extreme stress and tension they place on their growing feet. Improper pronation, the rolling movement of the foot during walking or running, and obesity are all additional conditions linked to causing Sever’s disease.

The first step in treating Sever’s disease is to rest the foot and leg and avoid sports activity which only worsens the problem. Over the counter pain medications targeted at relieving inflammation can be helpful for reducing the amount of heel pain. Combined with rest and pain medication, a child with Sever’s disease should wear shoes that properly support the heel and the arch of the foot. Consider purchasing orthotic shoe inserts which can help support the heel and foot while it is healing. Most patients with Sever’s disease symptoms report an eventual elimination of heel pain after wearing orthotic insoles that support the affected heel.

Sever’s disease may affect just one heel of either foot as well as the heels of both feet. It is important to have a child experiencing heel pain get an examination by a foot doctor who can apply the squeeze test, which compresses both sides of the heel in order to determine if there is intense pain. Discourage any child diagnosed with Sever’s disease from going barefoot as this can intensify the problem. Apply ice packs to the affected painful heel two or three times a day for pain relief.

Exercises that help to stretch the calf muscles and hamstrings are effective at treating Sever’s disease. An exercise known as foot curling, in which the foot is pointed away from the body, then curled toward the body in order to help stretch the muscles, has also proven to be very effective at treating Sever’s disease. The curling exercise should be done in sets of 10 or 20 repetitions, and repeated several times throughout the day.

Treatment methods should usually continue for at least 2 weeks and as long as 2 months before the heel pain goes completely away and the child can resume normal physical and athletic activities again. A child can continue doing daily stretching exercises for the legs and feet to prevent the heel pain of Sever’s disease from returning.

Arthritic Foot Care

In our lifetimes we walk 75,000 miles, putting a great deal of stress on the 26 bones and 30 joints in our feet. As we age, our feet lose flexibility and elasticity. Our shock absorbers weaken, and if you add arthritis to that combination, joints become inflamed and distorted. Arthritic foot care becomes imperative at this point.
Start taking better care of your feet by buying better fitting shoes. Hammertoes, neuroma, and bunions form when our shoes fit poorly. Buy shoes with a lower heel and with more room in the shoe. Rheumatoid arthritis will cause you to lose your arch. Buying shoes with arch support will help, as will buying shoes that contour to your foot.
Leave a fingers width between your foot and the shoe. If your finger cannot fit inside your shoe when it is on your foot, it is too tight. Buy rubber soled shoes. The cushioning of the rubber absorbs shock and the flexibility of the rubber helps the ball of the foot, where you push off from as you walk. Look for square or rounded toed shoes giving your toes lots of room to move.
Exercise will also help. Stretching the Achilles tendon, the cord at the back of the heel, will prevent further pain and injury. This will also increase your foots mobility. Lack of mobility will cause significant stress and pain. Massages will also alleviate some pain. Knead the ball of your foot and your toes from top to bottom.
To stretch your Achilles tendon, lean against a wall, with palms flat on the wall. Place one foot forward and one foot back with the heel flat on the floor, then lean forward. Feel the pull in the Achilles tendon and calf. Hold for five seconds and repeat three times. The big toe stretch is another exercise that may alleviate stiffness. Place one thick rubber band around your big toes. Pull the toes toward the other toes on the foot. Hold for five seconds and repeat ten times. Another exercise to try is the toe pull. Place a thick rubber band around the toes of each foot. Spread your toes for five seconds and repeat ten times.
Pain can be alleviated with non-steroid, anti-inflammatory drugs, heat, and ultrasounds. Topical medications with Capsaicin may also help. Thus far, there is no remedy for pain that is one hundred percent effective. Buying shoes that give your feet plenty room with low rubber heels and soles will help. If needed, use heat and anti-inflammatory drugs, and exercise your tendons and toes. Lastly, arthritic foot care should incorporate massages to help your feet with circulation and to relieve the stress locked up in your feet.

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