<%@ Page Language="C#" ContentType="text/html" ResponseEncoding="iso-8859-1" %> Meridian Family Foot & Ankle Clinic of Oklahoma City Heel Pain
 
 
Meridian Family Foot
& Ankle Clinic Of
Oklahoma City
405-751-6152
 

HEEL PAIN

  

It is estimated that 15 percent of all adult foot complaints involve heel pain.  Heel pain from plantar fasciitis and heel spurs is characterized by sharp pain, aching, or stiffness on the bottom of one or both heels. The pain is often worse on the first few steps out of bed in the morning or after sitting down for an extended period then attempting to walk. As the condition progresses, there can be pain with every step. Heel pain originates deep within the foot, directly under the heel bone within the connective tissue. The pain is caused by excessive pull of a very thick ligament called the plantar fascia. This ligament's function is to help support the arch. When the arch depresses or flattens out more than the ligament can withstand, the ligament pulls or tears away from the heel bone (calcaneous). At this stage, the condition is known as plantar fasciitis.  As a result of this tear, the heel bone develops a rough surface. After several of these tearing episodes, a heel spur is formed on the heel bone and the condition is called heel spur syndrome. We have found that the presence of the spur is not the cause of the pain. The pain is actually due to an excessive pull and inflammation of the plantar fascia caused by flattening of the arch. In most cases heel pain can be relieved without surgery.

What Causes Heel Pain?

  • One of the most common causes of heel pain is a sudden change in physical activity.
  • A change in jobs  from one that was primarily sitting, to one that is primarily standing and walking is a very common event that leads to heel pain. 
  • Also, taking up a new sport such as tennis, ,jogging, aerobics, dancing, or even walking can result in heel pain.   
  • An increase in body weight can put stress on the foot.  This, combined with non-supportive shoes and increased standing can resulting in heel pain.
  • Going barefoot for long periods of time can cause heel pain.
  • Wearing flat, non-supportive shoes or any foot gear which allows the foot to flatten excessively can cause heel pain.
  • Flexible feet and high arched feet are foot types that, combined with any of the above, are particularly likely to develop heel pain.

How Do You Prevent Heel Pain?

  • To prevent heel pain, avoid a sudden change in physical activity.
  • If you are taking up a new sport, do some conditioning before "going for the gold" In other words, ease into your new sport gradually.
  • It is also very important to wear the proper shoes. Two hours of aerobics or dancing in flat canvas sneakers can cause a lot of damage to the foot.
  • Well-fitted running shoes will suffice for a number of sports and occupations, and are especially good for walking. Avoid going barefoot.
  • Finally, keep your weight under control.

How Is Heel Pain Treated?

         Self Care

  • Medication: over the counter anti-inflammatory medications such as Advil, Nuprin, and Motrin are effective in helping to alleviate this type of pain. It is important to take this kind of medication with food and discontinue using them if stomach upset or heartburn is noticed. If you have a stomach ulcer, you should not take this kind of medication.
  • Change in the type of shoe: avoid wearing flat, unsupportive types of shoes such as flat sandals, Keds, deck shoes, etc. Also, avoid going without shoes. A good type of shoe to wear as much as possible is an athletic type of shoe such as New Balance, Nike, Reebok, or any brand name walking shoe such as Rockport, Merrill, Foot Joy, or SAS. Surprisingly, most women notice less heel pain when wearing heels and men find relief when wearing cowboy boots. Adding an over-the-counter arch support may help alleviate some of the pain as well.
  • Modifying your activity: This is perhaps the most important form of self treatment. Standing in one spot for long periods of time should be avoided. Sit as much as possible, and if you can, elevate your feet.
  • Ice and stretching: placing the bottom of the heel on a zip lock bag filled with crushed ice or a bag of frozen vegetables tow to three times a day often helps relieve heel pain.  Stretching the plantar fascia by rolling your foot over a coke bottle may also help alleviate heel pain.  You can do both at the same time by filling a large plastic cola bottle with water, placing it in the freezer until it is frozen, then rolling the arch and heel of your foot over the bottle two to three times a day.

 

    Professional Treatment

  • Orthotics: If the above self-care measures are not effective in alleviating your heel pain, professional care is needed. Treatment of chronic heel pain is centered around the use of a custom orthotic designed and constructed for your specific foot type and biomechanical needs. An orthotic is a custom-made device, sometimes incorrectly referred to as an "arch support." After a complete biomechanical examination, a computerized gait analysis is performed in our office. After the gait analysis Dr. Hines evaluates the results and designs a customized orthotic to the exact shape of your foot with the appropriate corrections and accommodations for your specific needs and activitiy.  Our orthotics are made of high impact plastic material and are worn inside the shoe. They fit well in most walking shoes, or casual types of shoes that have a removable foot bed or insole. Dress shoes may be worn for short periods of time without the orthotic or a special dress orthotic may be necessary and are available for both men and women. The purpose of the orthotic is to control abnormal foot motion relieve the strain on the planter fascia.  It is estimated that 90% of heel pain resolves with the use of a customized orthotic.

          

  • Cortisone Injections: Once the mainstay of treatment, cortisone injections are falling out of favor as a treatment for heel pain.  Research has shown that cortisone can weaken the plantar fascia resulting in rupture.  Most heel pain can be managed with orthotics alone. However, some heel spurs need additional treatment and if surgery is not possible, injections can be performed in selected cases.  Also, cortisone should not be injected more than three times in the same area in a lifetime due to its tendency to cause the fatty padding over the heel spur to shrink or atrophy. As a result, too many injections can actually make the pain worse.

  • Endoscopic Microdebridement Plantar Fasciotomy: This is the latest advancement in the treatment of chronic heel pain that fails to respond to orthotics. The treatment is called Endoscopic Microdebridement Plantar Fasciotomy, or EMPF. This procedure involves the use of electrical current applied to the plantar fascia through a small scope similar to the one used in knee surgery. This specialized electrical current causes an increase in blood supply, reduction in the thickening, and a dramatic decrease in pain in the plantar fasciitis.  After EMPF surgery, most patients are able to return to shoes with orthotics the next day and return to most activities in 3-4 weeks. With this new procedure there is a considerable reduction in the recovery time compared to surgery previously used for heel pain. It is necessary for patients to continue to wear orthotics after the EMPF procedure in order to prevent recurrence of the condition.

  • Extracorporeal Shock Wave Therapy (ESWT): is another treatment for chronic heel pain. This non-surgical procedure uses high-energy shock waves to increase blood flow and stimulate healing of the plantar fascia. The machine that performs this treatment is similar to the Lithotriptor that is used to treat kidney stones. This procedure is relative new and still under investigation. I have done several treatments with this device and the results have not been as good as the results with the endoscopic microdebridement plantar fasciotomy (EMPF).

To schedule an appointment, please call (405) 751-6152