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“Oh, my aching feet!”

Heel spur syndrome, plantar fasciitis among causes of foot pain

It’s difficult getting up on my feet because my heels are so sore.” “Some days I just want to cut my feet off, they hurt so bad!” “I can’t exercise to lose the weight I need because my heels are so sore whenever I walk!” These statements are but a few, heard in my podiatric practice. Heel pain can be quite limiting and many people believe that they have to simply “deal with it.” Many believe the pain will eventually go away, and that there is no reason to see a doctor.

Sometimes that belief is sound. Certain types of heel pain resolve themselves within a short amount of time, while other conditions can last months, to years. Heel pain, untreated, may cause many more problems than just the pain in the heels, such as, depression, weight gain and inactivity.

Not all heel pain is the same. Numerous conditions cause heel pain. Young children may experience heel pain from a condition known as calcaneal apophysitis. Young adults may have a condition known as “Reiter’s”Syndrome or “Lover’s Heel,” brought on by a sexually transmitted disease. “Spurring” into the Achilles’ tendon; or bursitis around the Achilles’ tendon might also cause people pain and discomfort.

Various arthritic conditions present themselves in the rear foot. Nerve impingement problems and atrophy, or (wasting away), of the fat pad also may cause severe heel pain. Other conditions affect the heel area, but the most common complaint, is that condition known as” heel spur syndrome” or “plantar fasciitis”.

Heel spur syndrome is one of the most common complaints heard in a podiatrist’s office. Patients often describe the pain in their heel as worse with the first step each morning, and better after being on their feet for an hour or so.

The area is usually quite tender and patients say,” they must walk on their toes” for a few minutes, until the heel calms down. Once the day’s activities begin and after being active on one’s feet for half an hour or so, the pain about the heel quiets down and the patient is usually able to walk more comfortably. Than after sitting for a short period of time, and getting up to walk, the ‘same pain’ returns.

Heel spur syndrome is, in its literal definition, inflammation and pain about the origin of the plantar fascia or heel, with or without a bony spur. Plantar fasciitis is the condition in which the plantar fascia is irritated, but a spur is not present on the calaneous (heel bone). These two conditions, are usually, treated the same.

The plantar fascia is a ligament that attaches to the heel bone and spreads out along the bottom of the foot toward the toes. It loosely functions to maintain the arch. In a normally functioning foot the plantar fascia is not stressed excessively; but in a patient with very high arches or flat feet stresses are greater.

Over years of wear and tear, our feet are prone to injury and stress. These stresses may be severe enough to cause the plantar fascia to pull harder on the heel bone and result in bony calcification, or spurring; or, in rare cases, a stress fracture of the heel bone.

Most commonly, patients are taking anti-inflammatory medications, such as, Ibuprofen or Aleve, or a prescription medicine. In addition, the patient has tried various shoes or inserts. Perhaps, stretching exercises have been implemented, or the patient has received some form of physical therapy. All of these are instrumental for treating the painful condition known as plantar fasciitis. The patients, who have received little or no relief, need more focused attention from a Podiatric (foot) specialist. Nearly 85 percent of all patients, diagnosed with plantar fasciitis, will get better, with aggressive, conservative therapies; while, only about 15 percent of people, with this same condition, will not, and, may need surgical intervention.

Conservative measures include; anti-inflammatory medications, steroid injections, stretching exercises, ice message, and appropriate footwear or orthotics. Certain individuals, are casted, in a below the knee cast, as a means to keep the plantar fascia “stretched,” or night splints, are ordered, to maintain a 90 degree angle, between the foot and the leg – again, “a simple way” to keep a constant stretch, on the plantar fascia. In recalcitrant, or ‘stubborn cases’, surgical intervention is necessary to provide the best result.

There are two common, surgical procedures, performed, for the treatment of this condition. The first is an openresection, of the plantarfascia, either, through an incision, made on the side of the foot, or, on the bottom of the heel. Recovery for this procedure may be several weeks to months, due to the size of the incision. But, this procedure is very effective in treating plantar fascia.

Another common surgical procedure is one in which just the plantar fascia is released, either from a small medial or plantar surgical approach. The recovery for this procedure is short due to the small incision.

Finally, a revolutionary procedure is commonly performed now using Platelet Rich Plasma (PRP) and after the patient’s whole blood is spun in a centrifuge, the PRP portion of the blood is injected into and along the attachment site of the plantar fascia. Most patients find near complete relief of their pain and symptoms by week eight post this minor procedure.

No matter what the cause of your heel pain, you should seek the advice of a physician or podiatrist. The longer a person “tolerates” heel pain, in particular, plantar fasciitis, the longer it will take to heal and the more advanced procedures will be necessary.

By Dr. Chris N. Bryant

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