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Posts for: December, 2014

By contactus@rebyfootcare.com
December 21, 2014
Category: F.Y.I.
Tags: heel   orthotics  

CUSTOM FOOT ORTHOTIC devices can be used for many deformities and conditions that affect the foot and ankle.  Plantar Fasciitis or Heel Spur Syndrome, however, is one of the primary indications for using custom foot orthotic devices, and for any arch support or insole.  Plantar fasciitis is a totally MECHANICAL problem, where the arch is under stress and strain because of a tight plantar fascia.

  The plantar fascia is the thick, avascular (no real blood supply - hence it looks white and not red like muscle tissue) ligament that starts on the bottom of the heel, runs up through the arch into the ball of the foot, and ends as it sends off small slips into the toes.  There are many reasons that people suffer with heel and arch pain that comes from a tight or strained plantar fascia.  Long periods of standing on hard surfaces, excessive weight, sports activities, and functional/structural foot deformities such as flat feet and high arch feet are just a few of the things tha can cause the fascia to pull harder and result in the condition known as plantar fasciitis. 

A mechanical or functional cure often works as well as, if not beter, than other treatments such as injections, oral NSAIDs, physical therapy. or surgery.  Unlike a injection, which is often very beneficial for immediate or almost immediate short term reief, orthotic devices take time.  A cast or 3D image of the foot is made, almost always for BOTH FEET, even if one foot does not hurt.  This can be done using a plaster slipper cast of both feet, a fiberglass sock cast of both feet, or an electronic scan, where the patient stands and/or walks over a force plate connected to a computer which records high and low pressures when the bottom of the foot hits the ground.  A lab then takes the scan or cast and creates a device (often semi-firm to firm for heel and arch problems) which creates a more ideal position and weighbearing pattern for the foot. 

These can be full length (all the way to the tips of the toes), sulcus length (ending at the base of the toes), or 3/4 length (which ends near the ball of the foot, fits easier in the shoe, and is usually adequate if no toe or metaarsal head problems need to be accounted for).  The devices are then sent back to the doctor who ordered them, and they ae then dispensed to the patients.  Just like with contact lenses, there is usually a breaking-in period.  This may be a matter of a few days, or as long as a few weeks, and often depends on the age of the patient (children are usualy quicker to adjust), the hardness or rigidity of the device, any other lower extremity problems (like knee or hip problems) and how much correction is needed in the devices.  

Follow-ups and adjustments are sometmes needed, but in many cases, improvement is seen fairly quickly.  After wearing the devices for awhile, there is a tendency for many people to forget about their heel problem after a few months, and to eventually go without the devices.  There are many cases where patients "lose" the devices, and two or three years later, come back saying that the pain was gone for over a year, so they tought they "didn't need them anymore."  After 6 to 12 months without them, the pain came back.  If you have pain in either or both heels or arches, and other treatments have given only temporary or partial relief, consider orthotic devices.   They may just be the best investment in YOU that you have ever made! 

 

Richard S. Eby, DPM

(423) 622-2663


By contactus@rebyfootcare.com
December 15, 2014
Category: F.Y.I.

HEEL INJECTIONS can be of more than one type.  For the purposes of this discussion, we will be talking about STEROID INJECTIONS for heel pain, primarily for Plantar Fasciitis.  Injection  into the bottom of the heel for plantar fasciitis, or what has often been called "heel spur syndrome" is very common, and in many cases, very effective. 

Note that I said IN MANY CASES.  The term Plantar Fasciitis implies that there is inflammation within the ligament we know as the plantar fascia, and that is what causes the pain that heel pain sufferers are very familiar with - pain on arising first thing in the morning, pain that gets worse after walking following a period of rest, pain that is often worse barefoot or when wearing flat or non-supportive shoes.  But the pain we are talking about is due to a MECHANICAL cause, and NOT an inflammatory cause.  There is usually no swelling, redness, or other signs of inflammation in the heel or arch. 

There may be thickening or degeneration of the plantar fascia, which can be seen on Ultrasonic imaging of the foot, and can be very helpful.  But there is NO real inflammation.  Microscopic studies of the "diseased" or thickened plantar fascia that was removed surgically have consistently showed NO signs of inflammation.  So why do non-steroidal medications taken by mouth and steroid injections usually help, at least to a degree?  They have PAIN relieving properties as well as anti-inflammatory properties. 

It has also been showed that the act of "needling" the fascia can help in reducing pain.  It is possible that the act of putting a needle into the fascia can cause it to repair itself, at least to a degree.  Injections can be given into the heel under ULTRASONIC GUIDANCE, making the delivery of the steroid medication more precise.  While steroid injections are not without their risks, the bottom of the heel, with its typically thick pad of fat, is a much safer area to inject than thin skinned areas such as the sides and tips of the toes, or especially the BACK of the heel, where the Achilles Tendon can be damaged or even rupture, especially with repeated injections. 

It is possible to rupture the plantar fascia with steroid injections, but this is fairly uncommon, and since the plantar fascia is not a tendon or muscle, and simply a ligament, there is no loss of function if that should occur.  Surgery for plantar fasciitis, which should only be considered when conservative treatment fails, involves a deliberate cutting of the tight plantar fascia.   Steroid injections should NOT be given haphazardly or repeatedly if no benefit is being obtained with them, but in may cases, corticoteroid injections can give significant relief to the plantar heel pain sufferer, and may eliminate the need for invasive surgery. 

 

Richard S. Eby, DPM

(423) 622-2663


By contactus@rebyfootcare.com
December 07, 2014
Category: Nail Treatments
Tags: foot   heel   alternative   plantar fasciitis  

  Whether we are talking about PLANTAR FASCIITIS (the most common cause of heel pain) or RETROCALCANEAL SPUR with Achilles Tendonitis, there are MANY available treatments.  Traditonal treatments for heel pain, which are usually tried first, include stretching exercises, NSAIDs (oral anti-inflammatories), ice, heat, rest,  heel cups, heel lifts, shoe modifications, over the counter supports or insoles, custom orthotic devices, night splint/AFOs, topical pain creams and rubs, steroid injections, physical therapy, and of course if all else fails....surgery. 

Then...there are a number of "alternative" treatments.  Some of these are fairly common, while others are a little more unusual.  Today, we will give a general overview of these available alternatives, all of which are non-surgical, and will cover many of them in much more detail in later posts.  So, here they are, in no particular order:  SHOCKWAVE (low energy and high energy), PRP (Platelet Rich Plasma), PEMF (pulsed electromagnetic therapy), OZONE INJECTIONS,  PODIATHERM,  and LASER TREATMENT.  I am sure there are others, but for now we are talking of treatments that are NON-SURGICAL and/or NONINVASIVE  (the Podiatherm is an exception because it does involve making a small incision) treatments for heel pain. 

One could also include herbal medications and acupuncture, but since I have no experience in these treatments, I will not cover these,  and I am sure there are some others that are used in certain cases.  What most of these treatments have in common is that they have little or no known (serious) side effects,  are done for the soft tissue problem causing pain and not bone, are usually not covered under traditional health insurance plans, are not done by a large number of physicians, but in many cases they are more "natural" type treatments that can sometimes result in very good outcomes and in some cases can result in a "cure" more than , say, a cortisone type injection, which almost always "wears off" after a period of time. 

Additionally, most of these involve either increased oxygen to the tissues - either directly, as in the case of ozone, or indirectly, as with PRP or Shockwave, where there is an increase in inflammation and then increased bloodflow to the area.  The increased bloodflow also resulting in increased oxygen in the tissues.   The Podiatherm is again, a bit of an exception here, because it is used more for nerve pain (entrapment) in the heel, and primarily works by heating up the nerve and making the nerve non-functional and basically causes an area to become "numb."   On the next few posts, we will go a little deeper into these treatments.

 

Richard S. Eby, DPM
(423) 622-2663