Author’s injury gets many treatments

Conway McLEAN, DPM

Heel pain is one of the most common orthopedic conditions encountered by physicians today. About one out of three Americans experience a bout of it at some point in their lives. Significant work hours are lost due to this sometimes debilitating malady. Add in the health care dollars that go into the treatment of heel pain and this should be considered a serious national health care problem.

What is responsible for causing such pain and heartache? An analysis of the diagnoses associated reveals many possible etiologies. The list of causes is extensive and includes such disparate conditions as bursitis (an inflamed sac of fluid the body builds in the area), a stress fracture of the heel bone, a trapped nerve, bone tumors (fortunately not common), and, most commonly, plantar fasciitis (a strained arch ligament).

This latter structure, which runs along the bottom of the arch, helps to support this important component of our skeletal structure. Consequently, any of a multitude of situations causing stress to, or lengthening of, the arch, can, and often does, lead to pain. Because weight bearing is something pretty much everyone does, on a regular and repeated basis, heel pain is a recurrent and resistant complaint for many sufferers.

Understandably, an injury to the heel can result in chronic heel pain. This may cause the aforementioned stress fracture to the heel bone. Alternatively, there can be injury to the plantar fascia, which may include a tearing of this structure. I can speak personally to this latter situation.

I play soccer on a regular basis, and have done so for many years (decades, actually). I recently was playing locally when I experienced a sudden sharp pain in, you guessed it, my heel! I should mention that I had experienced some plantar fascial symptoms over the previous week, indicating the development of some inflammation in this area. When a ligament is inflamed, it is not as strong. Thus, the physical stress of sprinting, then turning sharply and suddenly was sufficient to cause a tear of my weakened fascia.

You have to figure if this particular injury is going to happen to anyone, I’m a good candidate. I could not begin to guess at how many people I have treated for heel pain over my many years of practice (and I’m not saying how many that is!) Having achieved board certification in podiatric orthopedic medicine, I have abundant experience at treating this problem.

Treatments for plantar fasciitis are many, covering a tremendous variety of modalities, techniques, devices and medical specialists. This is just more evidence of the widespread nature of heel pain. An internet search will reveal all-manner of magic cures, each touting theirs as the best, each guaranteed to resolve your discomfort. Because heel pain varies greatly in its severity, as well as in its cause, some of these do help. Many cases of plantar fasciitis are relatively mild, and easily resolved. Something as simple as a decent arch support may be enough to reduce a mild case of plantar fasciitis. Then again, getting rid of your beaten, over-used shoes may be able to do that as well!

So let’s get back to my story. There I am, hobbling badly, in significant pain. What is a poor podiatric physician to do? Everything! Talk about the kitchen sink, I threw every possible, appropriate treatment at the injury. You should know that traumatic tears are treated somewhat differently than your typical case of plantar fasciitis. Surgery is basically never utilized for a fascial tear. Then again, operative treatment is rarely needed to resolve your standard case of plantar fasciitis

Time to get onto my soapbox. It is unbelievable that, in this day and age, people are still being told their heel pain is due to a heel spur. If a doctor has said this to you, my apologies. This is a falsehood, a prevarication, an outright lie. Your typical heel spur, a very common entity, is not a weight bearing structure. Many people have large, wicked-looking spurs but have never had a day of heel pain in their life. Conversely, I have seen many with unremitting, chronic pain, but not even a hint of spurring.

In the first 24 hours following my injury, confirmed by ultrasound examination as a partial fascial tear, I performed 12 different treatments! I wanted to get better, and fast! I was concerned, since recovery from this injury tends to be lengthy and slow. Often, those afflicted will be unable to participate in sports for a month or two. Unacceptable….where’s that kitchen sink?

I was in considerable pain when any pressure was applied, so pulling out the crutches was helpful. Immobilization is appropriate for a great variety of musculoskeletal conditions so donning my removable cast boot was performed at the earliest opportunity. A wonderful technique is the application of a specialized sports taping which takes tension off the arch ligament. I have used this method for years so, naturally, I had one of my staff apply one. For pain relief, I took an anti-inflammatory medication. Although I don’t particularly like prescribing pharmaceuticals since they are often nothing more than a “band-aid”, in this case, I wanted some relief.

Some effective physical therapy modalities were used as well, including ultrasound and electric stimulation. Probably the most powerful, effective technique that I chose was my cold laser. This is a newer technology, very different from any surgical laser, since it doesn’t produce heat. I took the laser home with me every day and used it. Repeatedly. Fortunately, this is one of the few methods in my “bag of tricks” which has no complications. It is so nice to be able to offer something to patients which can’t cause any problems.

As a result of my ministrations, I am happy to say that I was recovered sufficiently to participate in some athletic pursuits in about a week. This is a fairly remarkable recuperation (although healing is a very individual thing). I do ascribe much of my recovery to the repeated application of cold laser energy to the tear. Scientifically, I can’t say this with certainty, but I have used the laser on enough problems, both mine and others, to be able to say definitively, cold laser therapy is a wonderful treatment, and a great addition to the options I can offer people who present with musculoskeletal problems.

In conclusion, I would like to leave you with several messages. First and foremost, if you suffer from heel pain, know that there are a multitude of beneficial techniques and technologies available to get you relief. Although I didn’t mention all the health problems that can be successfully treated with a cold laser (chronic wounds, nerve problems, and others), it is an amazing piece of technology. I predict it will become an integral part of mainstream medicine. Also relevant, if a physician isn’t able to provide you with a clear and understandable explanation for your problem, perhaps you should wonder. And lastly, if you should suffer from a tear of your plantar fascia, become a podiatrist! Actually, that probably isn’t the best choice: go and see the appropriate specialist. That is a much faster approach!

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with an upcoming move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments