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Posts for tag: plantar fasciitis

By contactus@rebyfootcare.com
September 04, 2015
Category: Heel Treatments

  YES!  It is true.  There is a very good chance that if you have plantar fasciitis - the very bad pain on the bottom of the heel that starts hurting in the morning and acts up whenever you sit down and get back up on it - your pain will probably get better if you lose a little weight!  Now - by no means am I saying that ALL people with heel pain are overweight.  There are people who are very thin that have heel pain.  But the vast majority of people with pain on the bottom of the heel will see at least some pain relief, and many will see a LOT of relief, by losing a little weight.

   Plantar fasciitis is caused by a tightening of the ligament on the bottom of the foot that runs from the heel to the base of the toes.  When it becomes painful, it is due to a chronic inflammation, and sometimes small tears within that ligament or fascia.  Anything that causes more pressure on the foot - sports activities, long periods of walking or standing, flat feet, very high arch feet with weight concentrated on the heel, and excess weight - can make it worse.  While people of normal weight DO get heel pain, a large number of people where this condition is long-standing and very difficult to treat are...well...LARGE.  I once saw a woman get a single steroid injection into her heel, lose just 10 pounds (and the woman was just very slightly overweight to start) go for 14 YEARS without pain.  The really odd thing is that when she came back to me for a second injection, she said she had recently gained that weight back.  I've seen people have gastric bypass surgery after having uncontrolled diabetes, cardiovascular disease, AND heel pain - where after several unsuccessful to slightly successful treatments for heel pain LOST 80 to 100 pounds (and these were BIG people to start)...see their heel pain resolve COMPLETELY, the need for diabetic medication go WAY down or even eliminated.  Of course their blood pressure many times stabilizes as well.

A few years ago I bought an old house and decided I would "rehab" it.  That's basically fixing it up, and in my case spending more money on the supplies and labor than I did on the house!  To keep expenses from getting totally out of hand, I agreed to pick up some of the materials needed at Lowe's and Home Depot, and have them ready for the contractor to put in.  I have knee arthritis, so going up and down the 20 or so stairs at the front of the house was no fun anyway.  But just carrying cans of paint up those steps caused my knee pain to become excruciating.  If that wasn't bad enough, carrying kitchen cabinets up was even worse.  A few extra pounds made a hug difference in my knee pain, and it does the same to the heel.   

   Not every one will see heel pain resolve completely as a result of losing weight, but if you or someone you love has had heel pain for a year or more, it has not responded well to treatment, and you may just be carrying around a few extra pounds, give it a try!   Losing a little weight may just make a BIG difference in your level of pain.

 

Richard S. Eby, DPM

EbyFootCare

7348 East Brainerd Road

Chattanooga, TN.  37421

(423)760-3115

www.rebyfootcare.com

    Heel pain, especially Plantar Fasciitis, is one of the most common problems seen in the foot and ankle specialist's practice.  This condition is very easy to treat, but often not very easy to cure.  There are many conservative treatment options for this condition, and as with many other foot and ankle problems, surgery is also an option.  Surgery for this condition, however, should always be the LAST option, and only considered when conservative measures have failed to give significant relief of pain.  Why do I say this?  First of all, there is no treatment for plantar fasciitis or pain on the bottom of the heel that is over 80 or 85% effective in curing this problem.  Surgery is only effective in about 70% of cases of plantar fasciitis.  Some studies report an even lower success rate in the 50 to 60% range.  There are SO many conservative treatment options, some of which we will explore below, that surgery should be the DOCTOR'S AND THE PATIENT'S LAST OPTION!  

    Conservative treatments for plantar fasciitis include the following:  exercises, steroid (cortisone) injections, NSAIDS (oral anti-inflammatory drugs), night splints, custom orthotic devices, over the counter supports and insoles, physical therapy, shockwave treatment, laser therapy, PRP (injections of platelet rich plasma), walking boots, stem cell injections, and there are surely others that I just can't think of right now.  Oh, but some of these are "unacceptable" to patients - or in some cases, the doctor - because (1) it takes too much time  (2) it alters the type of shoes worn ...and of course.....(3) it may not be covered under insurance,  So...in many cases, the patient, and sometimes the doctor, chooses SURGERY.  After all, you get it done in one visit and "it's (usually) covered under insurance."  But the downside with the surgery is a lot bigger than the downside with any of these conservative treatments.  With any of these treatments, there is always a chance it may not work.  With surgery, not only is there about a 30 to 40% chance it won't work...but also....you may get an infection, or a slow healing wound, or long term swelling,  you may get a flatter or more unstable foot, or  nerve injury/entrapment, or problems with the anesthetic (if you are given general anesthesia), or you may have a different problem or pain after the surgery that you did not have before the surgery.   One procedure, which was quite popular in the 1990's was the Endoscopic Plantar Fasciotomy.  A very small incision was made on each side of the heel, and a small scope was inserted in one side, cutting the ligament from the other side.  In some ways, it was a very effective procedure, in other ways it was risky.  I did the procedure in selected cases, and still do from time to time, but it is NOT without potential problems.  For a few years. this procedure was done so quickly by so many foot surgeons, where conservative treatment was not even tried, that it caused one very prominent Chicago foot and ankle surgeon to refer to it as "the rape of the plantar fascia."  

     Am I saying that surgery should NEVER be done for plantar fasciitis?  NO.  There are cases where it is necessary, especially if a person has had constant  severe heel pain for 9 to 12 months and has had multiple attempts at conservative treatment with little or no improvement.  My point is to be patient - don't consider surgery because one or two things that have been tried did not work - and most of all, don't let your insurance company decide how you are treated.  Be prepared that many of the most effective non-surgical treatments take time and are not covered under insurance.  Surgery should be the LAST resort for this problem. 

 

Richard S. Eby, DPM

7348 East Brainerd Road

Chattanooga, TN.  37421

www.rebyfootcare.com

423-760-3115

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

 

By contactus@rebyfootcare.com
November 23, 2014
Category: F.Y.I.
Tags: ankle   foot   plantar fasciitis  

Plantar Fasciitis is one of the most common conditions that affects the foot.  Years ago, this was referred to as HEEL SPUR SYNDROME because a bone spur on the bottom of the heel is often seen with the condition we now refer to as plantar fasciitis.  Actually, the presence or absence of a "spur" on the bottom of the heel has little, if anything, to do with the pain one gets with this condition.

 Plantar fasciitis is a mechanical thightening that occurs, usually just in front of the bottom of the heel bone, at the attachment of the plantar fascia.  The plantar fascia is a thick, tough, ligamentous band that runs from the heel, through the arch and ends near the ball of the foot at the toes.  A number of things can cause this to become tight and cause pain, often when first putting pressure on the heel in the morning or after a period of rest.  BUT, the idea of INFLAMMATION in this ligament is simply not the case.

 While oral anti-inflammatory agents (also known as NSAIDs) such as Ibuprofen, Naproxen, and many others)  and steroid injections often reduce, and in some cases eliminate the pain, WHERE IS THE INFLAMMATION?????   Rarely does one see swelling, redness, or heat in the area on the bottom of the heel.  In fact, surgical removal of portions of the fascia, when sent for microscopic examination rarely show signs of inflammation.

 For this reason, there is a movement to change the name of this dreaded condition to PLANTAR FASCIOSIS or even PLANTAR FASCIOPATHY.  This name implies deformity or diseased areas within the plantar fascis rather than actual inflammation.  There are also cases where removing small parts of the plantar fascia that appear abnormal on ultrasound exams of the fascia, and "needling" the remaining fascia, or injecting stem cells and/or platelets that are separated from the patient's own blood can cause the body to "heal itself."

 Shockwave therapy, something we will go into more detail on later, can also cause the fascia to "heal" on its own.  These points seem to suggest that INCREASING the inflammation in and around the ligament is actually a good thing, and can lead to reduced pain, and in some cases, complete resolution of symptoms.  No matter what one calls it, plantar fascitiis is a condition that affects many people, and can be treated in a variety of ways.  

Dr. Richard S. Eby   

423-622-2663