OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Robert Hume, DPM

End your heel pain!

By Robert Hume, DPM

Plantarfascitis is the most common cause of heel pain and affects 2.5 million people each year in the United States. The plantarfascia is a muscular and ligamentous structure that attaches to the heel and runs the length of the arch of the foot. Its function is to preserve the arch. You feel pain when there is too much tension where the plantarfascia attaches to the heel. This results in inflammation and the formation of a heel spur. Most people consider the heel spur to be the source of their discomfort, but the pain is actually due to this inflammation or irritation at the insertion on the heel. The more chronic it becomes, the more difficult it is to treat.

Plantarfascitis can occur as the result of a sports injury and is frequently seen among runners. People who are overweight or with jobs that require a lot of standing or walking are also at risk. Flat feet and increasing age also play a role in developing this condition. Pain is usually most severe when getting out of bed in the morning or after periods of rest. The initial weight-bearing of the day typically causes the most symptoms, with pain on the bottom of the heel. Knee, hip and back symptoms may develop in chronic sufferers as a result of altering their gait. They compensate by transferring weight to the outside of the foot, which may cause stress fractures. Arthritic great toes also aggravate plantarfasictis because they cause increased tension on the plantarfascia.

Fortunately, this condition often responds to conservative treatment, which can consist of cortisone injections, proper shoes, prescription orthotics, plantarfascial night splints, and stretching exercises. A significant percentage of patients, however, continue to experience pain despite the best attempts at conservative treatment. Prior to the advent of shockwave therapy, the only hope for relief from heel discomfort was to consider a surgical release of the plantarfascia. This surgical procedure requires a long absence from work for recovery as well as extensive rehabilitation. This surgery is generally reserved for patients with very severe symptoms after all conservative therapy has been exhausted. Because of post-surgical discomfort, patients are required to use crutches for many weeks. Full recovery requires approximately three months, and the procedure must be performed in an operating room.

Shock wave therapy is different. It was developed to break up kidney stones and today is the standard treatment for urinary stones. For treatment of plantarfascitis, shock waves actually trigger or stimulate the body's own repair mechanisms. Because it does not require an incision, it does not have any of the severe post- surgical pain or problems associated with surgical plantarfascial release. This procedure can be performed in the physician’s office under local anesthesia and takes about 25 minutes. Postoperative pain, if any, is managed with over-the-counter pain medications and patients can immediately return to non-stressful activities. Patients usually improve in as little as one or two weeks, but full recovery may require a month or more. Stretching exercises are performed and patients continue to wear prescription orthotics. This procedure has been successfully performed by doctors in Europe since the early 1990s, and has proven to be a safe and effective alternative to the traditional treatment methods available. Shock wave therapy relieves pain and has a short recovery period. It has become a welcome addition to the therapeutic regime of practitioners trying to relieve discomfort in patients with this painful condition.

For more information, call Robert L. Hume, Podiatry » 715.835.8585 or 800.696.4863