Conway McLean, DPM, Journal columnist
There are debilitating medical conditions, and then there are issues we can live with and have to live with. Naturally, when a person suffers from chest pains or has difficulty breathing, they are likely to seek immediate medical attention. But many orthopedic complaints reveal themselves gradually, becoming more visible, more prominent, over time. Although painful, many Americans will live with these issues for years. Yes, they may frequently need over-the-counter painkillers, or reduce their activity level, or the infamous hot bath, trying to get by.
These chronic orthopedic conditions are familiar to most of us, either the result of a bicycle accident in youth or perhaps a sports injury in high school, even bad feet can lead to these non-disabling, chronic and painful…..that we can and must live with. Is this a healthy approach? No, as it can lead to reduced activity levels and therefore decreased heart health. There is also the very important issue of quality of life.
One of the most common of these chronic orthopedic conditions is pain felt at the bottom of the heel. This can develop gradually, getting worse over time, while others note the sudden development of a sharp, throbbing sensation from this area, often felt when weight-bearing after rest. Nearly one in ten US citizens experience discomfort in this area of their lives, with many describing the pain as debilitating at some point.
Although there are many causes of heel pain, by far the most common is plantar fasciitis, basically an inflammation of the ligament in the arch of the foot. It is a long strip of tissue, much like a ligament, that helps support the arch of the foot. Many reasons exist for the development of prolonged excessive stress on this structure, the most important being the function of the foot: the biomechanics of walking and standing.
One of the most interesting features of plantar fasciitis is the number of different treatments used to relieve pain and alter the course of the disease. The latter is relevant since it is often a recurring problem over the years. The treatment approach varies by health care provider. Some are more familiar with the pathology and all the different treatment options. Too often, surgery is chosen in haste, but studies show that it is rarely necessary. And complications from the most frequently performed procedure are common.
Many people self-treat their heel pain, some successfully and many less. As one might expect, “Dr Google” has a lot to say on the subject (often contradictory and inaccurate). Thousands of products are sold listing heel pain as a good reason to buy theirs. (When so many people suffer from this disease, it makes sense to list it as a method of treatment.) Because the mechanical movements of an individual’s feet and legs have a huge role to play in causing pain in the heel, arch supports are a common method. treatment.
Unfortunately, many of the products sold are ineffective for most plantar fasciitis. Of course, there are many causes of heel pain, but without a doubt, the vast majority are due to this pervasive condition. That’s part of the problem: Many factors are at work in those who repeatedly suffer from fasciitis. Their weight, the surfaces they walk on, their foot type, their shoes, their activities, all play a vital role. And that’s just the beginning of a long list of factors to consider in the evaluation and treatment of plantar fasciitis.
One of the most common problems is a tight Achilles tendon, with the cord attaching to the back of the heel. It is the largest tendon in the human body, with the greatest forces passing through it. An excessively tight Achilles tendon has a direct antagonistic effect on the fascia, increasing the likelihood of developing this condition. Not surprisingly, a high percentage of Americans have an overly strained Achilles tendon.
Stretching exercises for this structure are common but improvement is only achieved with prolonged exertion. Many people fail because of an ineffective stretching routine, either due to poor technique or inconsistency. For others, it can take months to make gains. Yet a recent study found that the benefits of an at-home stretching program were equivalent to a physical therapy program, where study participants visited the physical therapist’s office. Stretching devices are commonly prescribed and some effective designs are available. Others do next to nothing, only serving to frustrate the user.
Probably the most important treatment for sufferers is arch support, as mentioned. But they must be designed and constructed appropriately to provide relief. Many humans need a more personalized prescription device, a shoe insert called a foot orthotic or simply an “orthotic”. When a person’s gait is properly analyzed, their foot shape accurately copied, its function sufficiently understood, foot orthotics can safely and reliably resolve plantar fasciitis.
Too often, injected steroids only help temporarily and no other conservative therapy is attempted. The most common surgery involves cutting all or part of the arch ligament, which can provide relief a good percentage of the time. But all too often there are complications (as there can be with any surgery), a common one being an alteration in the mechanics of the individual’s foot. Naturally, this can have far-reaching consequences. Surgical technologies and techniques have advanced enormously over the past 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 this important structure, has a high success rate. But when it comes to plantar fasciitis, conservative measures are almost always successful. Don’t jump into the surgery; that’s not a “magic bullet,” capable of resolving any condition without risk.
There are many approaches to treating plantar fasciitis, that common cause of heel pain. Sometimes it helps to do more than one method at a time, but there is always a path to relief. As the famous TV show proclaimed, the truth is out there, the truth on your best path to heel pain relief. A thorough analysis will usually provide the information needed to create a comprehensive treatment plan. For lasting benefits, you need to find your way to pain relief.
Editor’s Note: Dr. Conway McLean is a physician who practices 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 in 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 certified in surgery, wound care and lower extremity biomechanics.
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