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Heel Pain

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PLANTAR FASCITIS, HEEL PAIN, HEEL SPURS AND THE LIKE —

Okay, so you have been told that you have a “heel spur” on your foot X-ray, or you just have this nagging pain in your heels or arches that begins the moment you step out of bed in the morning and limp all the way to the bathroom. The pain “eases” up after about 5-10 minutes, but starts right up the next time you are sitting and go to stand up on those sore heels again. What is going on?

Plantar fascitis is one of the most common problems I see in my practice. Because humans are bipedal, walking on two limbs instead of four, all of the body’s weight is supported by the arch ligament. And, for people whose jobs involve standing all day on cement floors, or carry excess weight, the problem gets compounded. Forevery additional one pound of weight we carry, each foot feels like it is carrying an extra five pounds.

The arch ligament, or plantar fascia ligament, stretches across the entire sole of each foot inserting in a narrow band in the heel bone and attaching in a fan like pattern in the ball of the foot. It functions like a truss, supporting all the bones of each foot. When the foot is too flat or on the opposite spectrum, too high, the ligament stretches to its maximum length and some fibers begin to tear. This causes inflammation and PAIN at the insertion of the arch ligament into the heel bone.

Some people with plantar fascitis will develop a heel spur, seen on an X-ray of the foot. The presence or absence of a heel spur does not influence the success or prognosis of treatment for this condition. It is mostly a diagnostic finding for the doctor.

Because of the stubborn and complex nature of this condition, treatments must attack the problem from different vantage points. We lessen inflammation with NSAIDs or cortisone injections and we gently stretch the tight plantar fascia ligament with a night splint and physical therapy. Finally, we address the foot deformities and overweight that cause this condition in the first place to prevent it from recurring. For this, I prescribe custom-made Orthotics (see my article on Orthotics). They will support the body’s weight and improve foot function, thereby relaxing tension on the arch ligament. When tension on the ligament is reduced, so is inflammation and pain.

Eighty-five percent of people with plantar fascitis will improve with this conservative approach. For those that do not, surgery to “lengthen” the arch ligament is performed. Surgery also has an eighty-five percent success rate and prolonged recovery, so I always recommend an exhaustive conservative effort before opting for surgery.

Let me know if I can assist you with this challenging problem.

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