SIX QUESTIONS TO ASK YOUR DOCTOR ABOUT HEEL PAIN

  SAN ANTONIO, TX - 04/18/2016 (PRESS RELEASE JET)

SAN ANTONIO, TX - 4/18/2016 (PRESS RELEASE JET)

San Antonio Podiatrist Advises Heel Pain Sufferers To Ask Six Questions

1) Is the pain worse after taking the first step out of bed in the morning or after rest?

Plantar fasciitis is the most common cause of heel pain affecting millions of people. The plantar fascia is the tight band of tissue that attaches to the base of the heel bone and to the bases of the toes. The more inflamed the fascia becomes, the more it contract while one rest which is the cause of the “first step” pain. If there is no first step pain, then plantar fasciitis may not be the cause. There are many causes of heel pain. Here is a discussion of some of the causes: http://sanantoniopodiatrist.typepad.com/my-blog/2010/01/heel-pain-getting-the-proper-diagnosis.html

2) Am I wearing the correct type of shoes?

It has been recognized for hundreds of years, that the midportion or shank of the shoe should not bend or twist but the flexibility should exist at the ball of the foot to allow the toe joints to bend. The components of the sole of the shoe include the outsole which is the seen on the bottom, the insole which contacts the foot, the midsole which is sandwiched in between the insole and outsole offering stability to the shoe and the shank, the part of the shoe providing resistance to bending and torsion in the middle. The shank is often placed within the midsole. The plantar fascia is strong in one way but weak in another way. The fascia has tremendous tensile strength or “pulling strength”: but will easily become damaged when subject to repetitive twisting. Steel shanks have existed for over 700 years only to become rare in recent years. The shank of the shoe may also be made out of fiberglass, graphite or other hard plastics. How shoegear affects heel and arch pain: http://www.southtexaspodiatrist.com/BD-How-does-shoegear-affect-heel-and-arch-pain?-535

Additional support may be provided by orthotic shoe inserts.

3) Am I getting symptomatic treatment for my heel pain or definitive, curative treatment?

Treating the symptoms of a disease can provide comfort but if the cause is not addressed or the symptoms covered up with drugs the disease can get worse, chronic and more difficult to treat. Heel pain due to plantar fasciitis is relatively simple to cure but if allowed to progress, can become challenging and sometimes debilitating. There are three stages of plantar fasciitis, acute plantar fasciitis, chronic plantar fasciitis and plantar fasciosis. The stages can readily be identified by examination of the fascia with diagnostic ultrasound or sonography. Acute plantar fasciitis is essentially a strain or sprain of the plantar fascia and is self limiting, treatable with ice, anti-inflammatories, rest and changes of shoegear. If acute plantar fasciitis is left untreated, it can progress to chronic plantar fasciitis. Chronic plantar fasciitis is also caused by longstanding biomechanical issues of the foot such as overpronation (rolling in), oversupination (rolling out) or a tight heel cord (Achilles tendon). Chronic plantar fasciitis can cause degeneration of the fascia known as plantar fasciosis. For a discussion of the three stages see: http://sanantoniopodiatrist.typepad.com/my-blog/2010/01/treatment-triad-for-plantar-fasciitis.html

4) Have cortisone shots been recommended by my doctor as a treatment for heel pain?

The term “cortisone” refers to a class of drugs termed “catabolic steroids.” Catabolism refers to the breakdown of tissue. Cortisone is often mixed with a local anesthetic and injected into inflamed tissue to provide symptomatic relief. Such injections can bring fairly rapid symptomatic relief and can get patients through the phase of acute pain. Nevertheless, cortisone is not curative. At the best, the injection provides relief while the body heels the injury. If the heel pain is longstanding or chronic, cortisone will only cover up the problem, often allowing it to worsen. There have been a number of reports in which cortisone led to rupture of the plantar fascia. A specialist trained to determine the cause of heel pain should be consulted.

5) Have prescription foot orthotics been offered as a treatment option?

A large percentage of heel pain is due to chronic plantar fasciitis. Chronic plantar fasciitis is caused by chronic repetitive strain of the plantar fascia. Obtaining the right shoes can be a big step to reduce such chronic strain but additional source of support and control of abnormal foot motion may be required. There are a number of shoe inserts available and the term foot “orthotic” is used loosely by many “sellers” of over the counter inserts. There are even retail outlets that claim to provide “custom fit” or custom orthotics. True prescription foot orthotics are made from a corrected mold of the foot at a professional foot orthotic laboratory to the specifications of a doctor trained in biomechanics of the foot. Such devices cannot be provided the same day, be made by having one step on a mat or a foam box. See http://sanantoniopodiatrist.typepad.com/my-blog/2014/05/orthotics-and-heel-pain.html

6) What treatment options have been presented if I have a tough case of heel pain or plantar fasciosis?

Chronic plantar fasciitis that has gone untreated or partially treated can progress to a degenerative process of the fascia termed “plantar fasciosis.” This was once termed “intractable plantar fasciitis” as it was considered difficult to treat. The difficulty centered around the expectation that is was still plantar fasciiitis an inflammatory, not a degenerative process. Plantar fasciosis can be readily diagnosed via diagnostic ultrasound and treated via several newer treatments: ESWT or extracorporeal shockwave therapy, the Topaz procedure or the TenexTX procedure. Dr. Davis has extensive experience with using the these three treatments for plantar fasciosis. See http://sanantoniopodiatrist.typepad.com/my-blog/2014/06/tenex-tx-procedure-a-new-minimally-invasive-option-for-treatment-of-heel-pain.html