Heel pain, also referred to as plantar fasciitis or heel spurs, is one of the most common foot conditions treated in a podiatrists office. In our fast paced lives, heel pain has become an epidemic. This is due to the combination of long work days and lack of exercise. People are also gaining weight and losing their muscle strength and flexibility. These are all contributing factors to heel pain. Typical symptoms consist of pain when getting out of bed in the morning and after sitting. Many people also experience discomfort at the end of the day or the day after exercise/strenuous activity. Others describe their pain as radiating or sharp shooting pain which likely involves a nerve in the heel area. A major support structure known as the plantar fascia is partially responsible for supporting the foot arch and for absorbing shock while walking. The fascia extends from the heel to the ball of the foot. The fascia is a flat band similar in makeup to a ligament. For various reasons, the fascia weakens and causes the arch to fall, thus developing a lower arch or flat foot". As a result, there is excessive stretch or tension on the fascial band which causes inflammation or swelling and often small tears of this band. With repeated stress of the fascia on the heel bone or calcaneus, a spur or bone enlargement develops. This is the body's way of responding to stress. When a tissue is stressed, the body forms more of that tissue, in this case bone. In addition to the swelling of the fascia, there is often a related irritation, entrapment or enlargement of various nerves around the heel. It has been shown that these nerves are a major source of the pain experienced with plantar fasciitis. So what exactly causes the pain in the heel? It is a combination of swelling of the fascia and the irritated nerves of the heel. The heel spur itself causes no pain even though on x-ray it looks pointed and appears as piercing object. As a matter of fact, many people have fasciitis without the spur. Dr. Marc Katz, a Tampa Podiatrist, notes that in his 17 years of practice he has rarely removed the actual bone spur. He also stated that over the past 10 years he has used advanced treatments to heal the pain and more recently has used a cutting edge technology known as Cryosurgery with a high success rate. Dr. Katz is the first Cryostar certified Cryosurgeon in the Tampa area for foot problems. How do we treat Heel Pain? Treatment of heel pain can be frustrating for the patient and physician. Healing can take months and sometimes as long as a year. This does not mean that there will be constant pain for that period of time, however, expectations need to realistic. It is important to seek early treatment. There are many treatments for heel pain. Your doctor should customize a treatment plan depending on individual factors including lifestyle, foot types and any other associated illnesses. Treatment should not only concentrate on the heel but also on the person as a whole. Many factors both physical and physchological may be important to consider. In addition, weight control, systemic medical conditions and injuries should be evaluated. Evaluations consist of a thorough history and physical, x-rays, diagnostic ultrasound and MRI if necessary. Referrals to other specialists may be needed if there are associated medical conditions. Treatment may include anti-inflammatory pills, ice, cortisone injections, custom orthotic arch supports, padding, strapping, night splints, removable casts, stretching, physical therapy, shockwave, homeopathic and natural medicine, change in activities, weight-loss programs, wearing different shoes, change in activities and change in life style. Dr. Katz stated that Cryosurgery is showing some excellent long-term results! This newer treatment is recommended after trying other treatments. However, at times it may serve as a first line treatment for certain patients. This procedure is done in the office and is minimally invasive and allows the patient to quickly return to normal activities. The patient is always advised that to help prevent recurrence of the condition, custom orthotic devices, continued stretching and body weight control are necessary. Treatment of heel pain can be a challenge. Find a Podiatrist that is compassionate and willing to spend the necessary time and try different treatment options.
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