The Ultimate Heel Pain Solution

The Ultimate Heel Pain Solution

 

 

 

Heel pain is the most treated condition at Gotham Footcare located in New York City.   This is not unexpected since New York City is a very walkable city with its fair share of marathon runners. 

 

Most common question asked by patients on their first visit is: Why am I getting heel pain?  Did I do something wrong?

 

For most part the answer is no.  Our patient’s heel pain is caused by nothing other than then the cumulative stress placed onto our feet with simple day-to-day walking as most New Yorkers commute by foot.  This repetitive walking and weight bearing activities develops heel pain as stress is constantly placed on the plantar fascia, which can result in micro tears and inflammation of the ligament.  Think of the plantar fascia as a bow, which stretches every time you place weight onto your foot.  The distance between its origin and its insertion increases which leads to subsequent pulling and tearing of the ligament.  Often times the body will compensate by forming a heel spur at the origin of the plantar fascia in attempt to shorten it’s length as it inserts into the ball of the foot.  The heel spur is not the cause of heel pain but rather the consequence of the pulling and tearing that occurs with repetitive walking.

 

What can cause the heel pain?

 

Plantar fasciitis, Achilles tendonitis and Posterior tibial tendonitis are all sources of heel pain. Plantar fasciitis is pain on the bottom of the heel, Achilles tendonitis is pain on the back of the heel and Posterior tibial tendonitis is pain on the inside of the heel.  Plantar fasciitis is the most common heel pain type mainly because it stems from casual repetitive walking, while Achilles tendonitis and Posterior tibial tendonitis is prevalent in athletes and runners as they are more prone to suffer from sports related injuries.

Other common etiologies for heel pain include tarsal tunnel syndrome, stress fracture, nerve entrapment, and inflammation of growth plate (calcaneal apophysitis).

 

Will the heel pain ever go away?

 

Acute heel pain is due to the inflammation of either the plantar fascia or the tendons. Conservative treatment options for the acute inflammation include rest, icing, stretching exercises, anti-inflammatory medications, shoe modification, and physical therapy. 

Recovering from heel pain can take 2 weeks to few months depending on the consistency of the treatments. If the acute pain is ignored for a while, the inflammation will leave a scar tissue and the pain will become chronic. Chronic heel pain is constantly painful and much harder to heal.

 

What are heel spurs?

 

Heel spurs are calcium deposits on the heel bone. They grow either on the bottom (subcalcaneal) or back (retrocalcaneal) of the heel bone. They occur as a result of chronic inflammation and strain of foot muscles and ligaments over a period of many months. It is very common to have a heel spur with heel pain. However, one might have a spur with no symptoms.

Treatment options for heel spurs and associated conditions include exercise, gel pads, custom-made orthotics, anti-inflammatory medications, and cortisone injections. If conservative treatments fail, surgery may be necessary.

 

What are diagnostic measures of heel pain?

 

In diagnosing plantar fasciitis, taking history and a complete physical exam are very important. However, diagnostic studies can play a very crucial role in ruling out other differential diagnosis.

Plain radiographs not only will help the physicians to evaluate the foot structure of the patients and determine if they have high arch (cavus foot) or flat foot (pes planus) leading to the heel pain, but also  reveal if the patients have posterior or plantar calcaneal spurs. 

In addition to structural evaluation, XRAYs will facilitate excluding heel fractures, bone tumors, bone cysts, or other etiologies of the heel pain.

Another effective and important modality is diagnostic ultrasound, which will help physicians to diagnose plantar fasciitis and exclude other pathologies such as cysts, fascial tear, heel spurs, and soft tissue masses.

Ultrasonography will measure the thickness of plantar fascia (in case of plantar fasciitis) through hypoechoic changes at the insertion of the fascia at the heel which represents the inflammation in the soft tissue. In chronic cases the thickness of the fascia can increase up to 4mm.

Magnetic resonance Imaging (MRI) is another common modality used for diagnosing heel pain etiologies. MRI is very specific and sensitive in confirming the presence of inflammation in plantar fascia, measuring the thickness of the fascia as well as determining partial and full ruptures of the tissue. The MRI findings can also support the clinical suspicion of soft tissue injuries and bone marrow edema as a result of the calcaneal stress fractures. Some of these pathologies require further studies in order to confirm the diagnosis.

 

How can I treat plantar fasciitis?

 

Treatment options for the chronic pain include PRP or stem cell injections, shockwave therapy, topaz procedure, Tenex, endoscopic plantar fasciotomy (EPF), and open fasciotomy.  All these treatment options mentioned above are available at Gotham Footcare.

If you are suffering from Plantar fasciitis or Achilles tendonitis and conservative treatments have not helped you? Tenex, a minimal invasive procedure might be the answer to your pain.

Tenex is a minimal invasive procedure developed in collaboration with the MAYO clinic. This advanced technique combined with ultrasound, uses ultrasonic energy and the innovative TX MicroTip® to target diseased tissue for precise cutting that removes only the scar tissue and leaves any healthy tissue alone. It is FDA approved and more than 85% of the patients are pain free within weeks of the procedure.

At Gotham Footcare, we offer traditional and advanced modalities such as Tenex Procedure for treatment of plantar fasciitis and tendonitis. Tenex can be done in the office with local anesthesia or surgical centers with sedation. It usually takes about 15 minutes and it does not require any stitches at the site. The foot will be dressed with sterile dressing.  Patients usually walk out of the office with a cam walker for few days. The procedure site should be clean, dry, and the dressing should be kept intact for a week. It is recommended that the patients continue with physical therapy and stretching after the procedure for few weeks. 

In our office we have treated many patients with Tenex procedure and in a year follow up, more than 90% of the patients are satisfied with the results and they experience much faster recovery time compared to open surgical options.

If you need a quick answer to your life long painful plantar fasciitis and tendonitis, Tenex procedure might be the right choice for you. 

 

Author
Dr. Sanaz Lalehparvar Dr. Sanaz Lalehparvar graduated from Shiraz University in Iran with a Bachelors degree in science and a Masters degree in Teaching English. Dr. Lalehparvar received her doctorate in Podiatric Medicine at New York College of Podiatric Medicine.Dr. Lalehparvar's residency training as Chief Resident was completedat Trinitas Regional Medical Center in New Jersey where she was trained in diabetic limb salvage, wound care, pediatrics, and reconstructive foot and ankle surgery. Dr. Lalehparvar is certified in American Board of Podiatric Medicine as well as Hyperbaric Oxygen Therapy. She is a member of the American Podiatric Medical Association, and American College of Foot and Ankle Surgeons. As a former avid basketball player and swimmer, Dr. Lalehparvar has a distinct interest in diagnosing and treating sport medicine related pathologies. She is committed to educating her patients on biomechanics of lower extremity and providing them with the latest medical advances.

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