Many new treatments for plantar heel pain
Human nature is a strange thing. This is especially true when dealing with health issues. Although our bodies possess amazing healing capabilities, many of us are resistant to the concept that, on occasion, good health may not be obtainable without some assistance. If you have pain from some extremity, and it continues for months, wouldn’t you say something, some treatment, needs to be applied?
And when a problem develops, some “tincture of time” may not be all that is required. Most of us are guilty at some point of assuming some problem or pain will simply ‘go away’. As most physicians would agree, men seem to be guiltier of this practice, ignoring some illness or condition in the belief that if denied long enough, the pain will disappear.
Times have changed, and the handiest medical consultant is clearly “Dr Google”. He’s everywhere, quite literally, and he has an opinion on every possible health condition known to exist. Unfortunately, the material you can access on the internet hasn’t been vetted. This may be shocking, but not all of it is accurate. Add to this the use of medical terms the lay public is not familiar with, and you have a recipe for misunderstanding, misinformation, and missed diagnoses.
So, let’s say, for the sake of argument, you have been suffering from heel pain. Many people do, sometimes for an extended length of time. We’re not talking about a few months, how about a few years! Every step can be painful, especially when getting up after sitting or resting. And the longer you are on your feet, the more pain you will tend to have. If this sounds like you, chances are excellent you are suffering from plantar fasciitis (plantar = bottom of the foot).
I am still amazed at how many people suffer from plantar fasciitis. Although the exact prevalence is unknown, it is estimated that more than 2 million Americans seek treatment for plantar heel pain each year. Depending on the study, estimates state that 1 in 10 adults will experience a bout of this condition at some point. For some, it is a self-limiting, frequently lasting just a few months, while others will have pain that continues for much longer.
Stretches of the Achilles tendon are one of the most common therapies recommended for plantar fasciitis. The Achilles tendon attaches to the back of the heel. When it is tight, it tends to create excessive pull upward on the heel bone, which has the predictable effect of forcing the arch down. Because the plantar fascia runs the length of the arch, this will result in increased tension on it, and thus lead to the development of inflammation and the associated pain.
Because of this relationship between the Achilles and the plantar fascia, various incarnations of a stretching device, usually termed a night splint, are used to assist in this beneficial goal of elongating the tendon. This is such an important and desirable objective, stretching the Achilles, that a surgical lengthening of the Achilles is now an accepted method of treating resistant plantar fasciitis.
Many techniques and treatments are used to treat this painful complaint. Home remedies abound, including various oils and pain-relieving topical agents. A topical anti-inflammatory can be prescribed, though this doesn’t treat any physical stress to the fascia. How about rest? That is a difficult thing, not standing, unless you are good at hopping. But actually, reducing weight bearing stresses is beneficial. How about home therapies? There are many, with icing, and the rolling of the arch over a frozen water bottle topping the list.
Many with heel pain will be referred to a physical therapist. Along with the stretches discussed before, the therapist will employ various machines designed to lower inflammation. These include therapeutic ultrasound, electrical stimulation, and several others. Once again, if your foot structure is such there is excess tension on the fascia, this approach tends to provide only temporary relief. And when the sufferer does obtain some relief from anti-inflammatory methods, plantar fasciitis pain is often recurrent.
Altering foot structure is rarely necessary (ie surgical reconstruction), but rather, altering mechanical function is the way to go. Without question, the most precise way to improve the way a foot is working while standing and walking, is with the use of a prescription, customized foot support, foot orthotics. These devices, when properly fit and designed, can be tremendously effective at reducing the tension on the fascia. Still, there are some individuals who do not get sufficient relief from conservative measures, and more unusual options need to be considered. And these days, there are many.
When conservative care has failed, surgery may be recommended, and has been for years. The procedure typically performed was a fascial release, in which all or part of the arch ligament was simply cut. This has the unfortunate consequence of changing the alignment of the arch. An uncomfortably high percentage of the time, various problems result from this procedure.
One of the most exciting new techniques for treating resistant plantar fasciitis requires the use of radio-wave generating devices. Some readers may recall mention of this technology in the treatment of ingrown nails. Here, the machine produces high intensity radio-waves which have the effect of vaporizing cells. This produces no burning of tissue, but creates many micro-cuts in the fascia, as opposed to the single, through-and-through cut of the traditional procedure (called a fasciotomy). There is no loss in strength of the fascia, and recovery is easy.
This is another example of minimally invasive surgical techniques, in which the work is done through the smallest openings possible. In this case, the openings are about the size of a pencil lead. No sutures are required, and minimal recovery time is needed. As is generally the case with minimally invasive surgeries, the risk of infection is significantly lessened.
Many individuals live with plantar fasciitis, and it doesn’t kill them. But living with pain reduces one’s quality of life, and stress is harmful to the human body. At a certain point, professional care is the smart way to go. Multiple treatments are available nowadays; it is rewarding to have so many options to offer patients.
Fortunately, the vast majority of plantar fasciitis sufferers can be relieved of their pain with conservative measures, and techniques like the radio-wave micro-fasciotomy are not necessary. But when needed, there are more ways than ever to relieve plantar heel pain. As a very partial witness, I can definitely say we are better able to care for, to resolve, plantar heel pain than ever before. I think it’s called progress!
Editor’s note: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at firstname.lastname@example.org.