Hi this is Dr. Kevin Lam, from NaplesPodiatrist.com talking to you now about heel pain.
Heel pain is one that most common things the podiatrists see in our practice
so let's get talking about the heel pain.
Now most the time people come in and say "Doc, I have pain in the heel / heel spur"
but in reality, most of the time the spur is not what's causing the problem
it's a tissue that's attached to the spur
and now I'll illustrate with this foot model right here
we're going to show right here, this foot model has the plantar fascia right here
this little band of tissue.
What is a plantar fascia?
The plantar fascia it's like this rubbery type of tissue
on the bottom of the foot as you can see.
This attaches -- this goes from the toes all the way attaches to the heel bone
as you can see where its marked red that's exactly where people typically get inflammation.
The heel spur is this little edge right about here
some people have small medium or large but you know, we found out through MRI technology
most of the time it's not the spur that's causing the pain, it's the tissue
the tissue, the plantar fascia, this rubbery tissue that attaches from the toes to the heel.
Now, what do we do with this?
Now once we get rid of the inflammation of the plantar fascia, the pain goes away.
Our typical treatment protocol is that we give non-steroidal anti-inflammatories,
we give a little injection, I give mine from the side in, get that little anti-inflammatory action
with the steroid or some people go from the bottom up.
there's other technology if that doesn't work or if your heel spur is really large
and sometimes we go in and cut the band of plantar fascia, take a little blade and
we cut it in the operating room
we cut the band as well as while we're there,
if you have a sizable spur, we'll grind down the spur.
Now that's not a very common thing that we do
that's only for people who don't respond to conservative treatment.
About ninety percent of patients actually do respond to conservative treatment.
Physical therapy is also important as you can see the Achilles tendon is actually continuous
with this thing called a plantar fascia.
A lot of times we find that people have the contracted Achilles tendon
called equinus deformities so this Achilles tendon is really tight
so we need to get that stretched with physical therapy.
Now why does stretching help this?
stretching helps this because a lot of times when you get inflammation and pain
you get a lot of inflammatory tissue
in order to get this tissue to heal we need to go ahead and stretch this tissue
through physical therapy, home stretching exercises, as well as electoral therapy
to help stimulate new blood cells in the area
that's why it can take anywhere from four weeks to six weeks for this plantar fasciitis to go away.
Some people get away with just an injection and it goes away in about two weeks
but majority of time is going to take four to six weeks of aggressive treatment with
physical therapy, injection therapy, non-steroidal anti-inflammatories and orthotic therapy.
Orthotic therapy what that does is not your Dr. Scholl, your shoe store type of inserts
where it just protects the arch, you really need a true orthotic from a podiatrist
to control the motion of the foot, helps to put all the structure at rest so you don't keep on pulling
on this heel spur or some people don't have the heel spur can still have this heel pain right here
but this tissue is pulling on the heel bone itself.
The longer this heel -- plantar fascia pulls on this heel bone, the spur will form or
get worse and that's something called Wolff's Law where the bone reacts to pressure and pull
so the more pull this pulls, the more non-supportive shoe that you wear
the greater that heel spur will be
so a lot of times when patients come in and the x-ray shows a nice sizable heel spur
I can tell that they have not been wearing good supportive shoes for quite some time
that's not something that forms overnight.
Hopefully I gave you some good information, stretching again is of utmost importance
and if that doesn't go away, definitely see a podiatrist, physical therapy, injection therapy
nonsteroidal anti-inflammatories is very important. Thank you.
This is Dr. Kevin Lam for NaplesPodiatrist.com