More than likely you are suffering from a foot condition called Plantar Fasciitis. Plantar fasciitis is inflammation of the plantar fascia. What the heck is the plantar fascia? Plantar means bottom and fascia refers to the particular type of tissue affected. This is by far the most common foot problem in Podiatry.
I have this problem. I initially started treatment for it about 16 years ago after suffering from a severe ankle sprain. Symptoms can include intense pain to your heel or arch area after getting up in the morning, or even after just sitting down at your desk for a few minutes and getting back up on it.
I tend to notice it most if I’ve been walking in the hospital all day or standing during surgery for an extended amount of time. A large majority of my patients are laborers, many from Toyota, but, I also have several from Keeneland that are up on their feet a lot during the day. Lots of hospital employees, from the janitors to the CEOs of the hospital suffer. Well, suffer no more, there are many treatment options available.
Techniques
Keep in mind, every combination of treatment is different and unique for each patient. I tailor your treatment around your job, activity level, age, etc. A few simple techniques just to get you started before you come in for an appointment include stretching and icing your foot.
Stretching includes a simple runner stretch. Place one leg in front of the next, making sure to keep the back leg straight, bend into it. What you want to feel is the stretch in your calf.
My personal favorite includes putting my toes against the wall, leg straight, and lean towards the wall. Also, you can place a belt or towel around the ball of your foot, and pull the towel back, pulling your “toes to your nose”. Perform this morning and night for 10 minutes each.
Ice
After a good stretch, have a bottle of water frozen in the freezer, remove the ice and roll the ice on your heel and arch while you’re having your cup of coffee in the morning for 15 minutes. Do it again in the evening.
Anti-inflammatory
An over-the-counter anti-inflammatory such as Ibuprofen will help alleviate your symptoms as well. Be careful if you have stomach issues as this type of medication can cause stomach irritation and potentially stomach bleeding. During your visit, I prescribe, if indicated a much stronger anti-inflammatory.
On your first visit, I use an ultrasound machine to visualize how severely inflamed your plantar fascia has become, only takes 5 minutes. Very similar to how doctors can visualize unborn babies. This will help guide me to see how severe your condition is, and I can tailor a treatment plan specifically for you.
The goal in performing each of these different techniques is to eliminate the inflammation in the area where the plantar fascia attaches to the heel bone. Many people have heel spurs, which generally are an indicator of how long he or she has suffered from this condition. Plantar fasciitis can come and go, I’ve found if we can do simple precautions, we can remain pain-free.
Because this plantar fascia is very taught as it pulls from the heel bone, we need to focus on supporting this “rubber band” like structure that is on the bottom of our foot. This is accomplished by obtaining a custom insert or called an orthotic. This is an insert that is specific for your particular foot shape, this is a prescription for you. No one else can put this in their shoe. Consider it similar to a pair of glasses. It’s an accessory, but a necessary accessory. Many people after wearing their custom insert can no longer walk comfortably without it. It’s addictive! Generally, you want to change them about once a year as our feet change, with children, depending on how fast they grow, maybe every 6 months. There are many techniques to get an orthotic fabricated. The majority of my patients use a gait scan.
What is a gait scan?
What is a gait scan? This is a computer-generated image that is obtained when you walk across this screen, it creates a 3-D image of your foot showing pressure points. It also can tell me to a tenth of a percentage if you have one limb longer or shorter than the other. Many people that suffer from knee, hip, and back pain have structurally one leg longer than the other. So, the rest of their body is compensating, they’re entirely out of whack. Also, many patients that have had trauma to their feet/ankles, had knee/hip/back surgery have a limb length discrepancy which can easily be balanced out with an insert for their shoe.
I also offer an over-the-counter insert, called Powersteps (different from what is sold in stores) to those who may not need a custom insert. Don’t waste your money at the big chain retailers, these can only be ordered by medical clinicians.
During your first visit, we review the above information and if you are suffering from intense pain from this condition, a steroid injection is offered. I know, who wants an injection to their heel? I’m just giving you the facts. The technique I use includes using cold spray to help numb the skin to decrease the pain from the needle. This injection feels like a bee sting and provides immediate relief. I DO NOT go in from the bottom, that would hurt even worse. I go in from the inside of your heel. My needle is not 6 inches long, it is 1 1/4 inches. A maximum of 3 injections is performed during an 8 month period.
Plantar fascial splint
During your appointment, I also fit a plantar fascial splint. I wear mine to the gym and to bed if I need to. This is different from the standard night splint which I find cumbersome, and can’t ever fall to sleep while I’m wearing it. The splint I dispense is a simple strap that goes around your ankle and a strap that goes to support and lift the fascia up. Most patients get immediate relief in the office when I apply it. In addition to the splint on your first visit, I do a foot/ankle strapping to support the fascia as well. Again, immediate relief.
Physical Therapy
Physical therapy is also utilized frequently to manipulate the fascia with deep tissue massage. Techniques that include putting a topical steroid to your skin and using ultrasound to penetrate the medication to the inflamed fascia are also performed. Stretching is also reviewed in detail and many, many other modalities.
If all of these techniques are not improving your painful heel, then we discuss more invasive procedures. It is called PRP, or Plasma Rich Protei, and only takes 15 minutes to perform. This involves getting a blood sample from your arm, just as if you were donating blood. All of the “healing factors” are then extruded from your blood, it is then infiltrated directly into your heel, so the healing factors can do their job and heal your painful heel.
Lastly, if still no improvement, we go back to the operating room and under light sedation the plantar fascia is clipped at the point where it attaches to the heel, alleviating the tension and pull. However, the majority of patients do not reach this last-ditch effort point.
Please call my office today at (859) 264-1141 to schedule an appointment today, so we can get you on the road to recovery now!