Heel Pain/ Plantar Fasciitis
by Jonathan Cutler, DPM
Heel pain is one of the most common foot ailments treated in a podiatric practice. It appears to be even more difficult to manage in South Florida with the prevalent hard floors in combinations with the love for non-supportive flip-flops and other poorly designed slip on shoes.
The main causes of plantar heel pain include foot structures on the extreme such as collapsing medial arch with flat foot type and rigid tripod high arch foot type. Other causes include sudden increased activity of increased weight due to excessive strain. Less frequent would be from trauma (fracture), osseous tumor, and nerve entrapment radiating from the tarsal tunnel region.
The typical symptomatic complaint is post-static pain especially first steps in the morning. This sharp pain usually subsides somewhat after a few steps and then becomes a dull ache throughout the remainder of the day. This is an inflammatory process along the origin of the plantar fascial band at the calcaneus. Without proper treatment, the inflammatory process continues and the symptoms will continue to exacerbate.
First line treatment regiment will often include:
- NSAIDs or medrol dose pack for patients with GI sensitivity.
- Medial arch support with strapping or custom made orthotics.
- Proper shoe gear such as tennis shoes rather than flip-flops.
- Icing.
- Decreasing activity (especially high impact).
- Stretching (either home therapy or institutional physical therapy).
- Night splints (part of home therapy).
- Cortisone injections (usually no more than a series of three)
If patients fail to respond to the first line of treatment, further radiographic testing such as MR imagines is warranted to rule out stress fracture or other complicating issues. Fortunately most patients improve significantly after the aforementioned conservative treatments.
For chronic or recalcitrant plantar fasciitis which have failed to improve, surgical treatment releasing the plantar fascial band is sometimes warranted. Fortunately, FDA has now approved extracorporeal shock wave therapy using acoustic energy (i.e. OssaTron) for the treatment of chronic heel pain. This is a non-surgical treatment which can be performed either in the office setting or surgical facilities (depending on the range of shock wave intensity and need of anesthesia). This is a 15 minute procedure that allows patients to full weight bear immediately and has over a 70% success rate.
South Florida Foot & Ankle Centers | Phone : (561) 793-6170 | FAX : (561) 795-3683
