Health Matters

Conway McLean, DPM, Journal columnist

There are disabling medical conditions, and then there are problems we can and do live with. Understandably, when someone suffers from chest pain or they have difficulty breathing, they are likely to seek immediate medical attention. But many orthopedic complaints reveal themselves gradually, becoming more noticeable, more prominent, with the passage of time. Although painful, many Americans will live with these problems for years. Yes, they may frequently need OTC pain medication, or reduce their activity levels, or the famous hot soak, trying to just get by.

These chronic orthopedic conditions are familiar to most of us, either the result of some bike accident as a youth, or perhaps a high school sports injury, even bad feet can lead to these non-disabling, chronic, painful problems…..that we can and do live with. Is that a healthy approach? No, since it can lead to reduced activity levels and consequently, lessened heart health. Also, there’s the very important quality of life issue.

One of the most common of these chronic orthopedic conditions is pain experienced on the bottom of the heel. This may develop gradually, worsening over time, while others note the sudden development of a sharp, stabbing sensation from this area, often experienced upon weight bearing after rest. Nearly one out of ten US citizens suffer from discomfort in this area in their life, with many describing the pain as disabling at some point.

Although there are many causes for heel pain, by far the most frequent is plantar fasciitis, basically inflammation of the arch ligament. This is a long band of tissue, somewhat like a ligament, which helps to support the arch of the foot. Numerous reasons exist for the development of prolonged excessive tension on this structure, the biggest being foot function: the biomechanics of walking and standing.

One of the most interesting features of plantar fasciitis is how many different treatments are used for the pain and to alter the course of the disease. The latter is relevant since it is often a recurrent problem over the years. The treatment approach varies depending on the health care provider. Some are more familiar with the pathology and all the different options for treatment. Too often, surgery is hastily chosen, but the studies show it is rarely necessary. And complications from the most frequently performed procedure are common.

Many people treat their heel pain themselves, some successfully and many not so. Predictably, “Dr. Google” has a lot to say on the topic (often conflicting as well as inaccurate). Thousands of products are sold listing heel pain as a good reason to buy theirs. (When so many suffer from this condition, it just makes sense to list it as a method of treatment.) Because an individual’s foot and leg mechanical motions have a huge part to play in the occurrence of heel pain, arch supports are a frequent method of treatment.

Unfortunately, many of the products sold are ineffective for most with plantar fasciitis. Of course, there are abundant causes of heel pain, but without question, the clear majority are due to this ubiquitous condition. This is part of the problem: numerous factors are at work in those who repeatedly suffer from fasciitis. Their weight, the surfaces they walk on, their foot type, shoe gear, activities, all play a critical part. And this is just the beginning of a long list of factors to be considered in the evaluation and treatment of plantar fasciitis.

One of the most common issues is a tight Achilles tendon, the cord attaching to the back of the heel. This is the largest tendon in the human body, with the greatest forces running through it. An excessively tight Achilles has a directly antagonistic effect on one’s fascia, increasing the likelihood of developing this complaint. Not surprising, a high percentage of Americans have an Achilles tendon which is too tight.

Stretching exercises for this structure are common but improvement is gained only through prolonged efforts. Many people fail because of an ineffective stretching routine, either because of poor technique or inconsistency. For others, it can take months to make gains. Still, a recent study revealed the benefits of a home stretching program to be equal to a physical therapy program, where the study participants went to the P.T.’s office. Stretching devices are commonly prescribed and some effective designs are available. Others do next to nothing, serving only to frustrate the user.

Probably the most consequential treatment for sufferers are arch supports, as mentioned. But they must be appropriately designed and constructed to provide relief. Many humans require a more customized, prescription device, a shoe insert called a foot orthosis, or just ‘orthotics.’ When someone’s gait is properly analyzed, their foot shape accurately copied, their function sufficiently understood, foot orthotics can safely and reliably resolve plantar fasciitis.

Too often, injected steroids help only temporarily, and no further conservative therapies are attempted. The most common surgical procedure involves cutting all or part of the arch ligament, and this can provide relief a good percentage of the time. But too often, there are complications (as there can be with every surgical procedure), a frequent one being an alteration of the individual’s foot mechanics. Naturally, this can have far-reaching consequences. Surgical technologies and techniques have progressed tremendously in the last few decades. Many operations are performed because it is the only recourse. The use of high intensity radio waves to remove diseased tissue from the plantar fascia, which does not involve cutting of this important structure, has a great success rate. But when it comes to plantar fasciitis, conservative measures are nearly always successful. Don’t jump into surgery; it is not a “magic bullet,” able to resolve any condition without risk.

There are numerous approaches to the treatment of plantar fasciitis, this usual cause of heel pain. Sometimes it is helpful to pursue more than one method at a time, but there’s always a road to relief. As the famous tv show once proclaimed, the truth is out there, the truth about your best path to heel pain relief. A thorough analysis will generally provide the information needed to create a comprehensive treatment program. For lasting benefits, you need to discover your path to pain relief.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula. Dr. McLean’s practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now the Keweenaw following the recent addition of an office in L’Anse. McLean has lectured internationally, and written dozens of articles on wound care, surgery, and diabetic foot medicine. He is board certified in surgery, wound care, and lower extremity biomechanics.


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