Heel Spur Syndrome, Plantar Fasciitis
The heel bone (Calcaneus) is the largest bone in the foot, and bears all of the body's weight with each step. Problems with heel pain are common for this reason alone. The common condition of heel spurs, also known as plantar fasciitis, is caused by inflammation at the insertion of the plantar fascia underneath the heel.
The plantar fascia is a dense band of tissue that runs underneath the foot from the heel to the ball of the foot. Biomechanical faults such as flat feet, or a tight Achilles tendon can lead to abnormal stress placed on the small attachment of the plantar fascia at the heel. This causes a ripping (microscopically) of the fascia off the heel, resulting in inflammation at the site as the body attempts to heal the torn tissue. The pain is usually worse with the first steps in the morning. The pain is chronic, because with every step, the fascia is being reinjured, never having an opportunity to heal.
On X-ray, a spur is sometimes seen. Rarely does the spur itself cause the pain - it is just the result of chronic inflammation at the site. Although the spur is not the cause, it is often diagnostic of the problem when seen on X-ray, and can help the podiatrist in ruling out other disorders such as stress fractures and certain types of arthritis. It should be noted that many times no spur is seen at all with this condition on X-ray.
Heel Pain Treatment
Initial treatment of this common condition consists of strapping the foot to keep the pressure off the affected area, anti-inflammatories, and a cortisone injection. Custom made orthotics for use in the shoes are the long term treatment once the acute pain has resolved. Sometimes a second or third injection is needed, and/or physical therapy. This conservative care is very successful - with an 80-90% success rate.
New Option: Arthrex has developed a new technique for office based use. A small sample of blood, (10cc's), are drawn from the patient and processed at the office. This produces a plasma that is rich in platelet growth factors that are responsible for healing. These factors have been used for many years to aid in slow healing wounds. The plasma is injected into the area of inflammation to resolve the pain. A second injection may be necessary. The area may become irritated initially but this should pass as the inflammation and pain are relieved. Additional information is available.
If conservative measures fail, surgery is considered.
Endoscopic plantar fasciotomy (EPF)
EPF is a minimally invasive surgical procedure that involves a small camera placed under the heel through 2 separate Œ inch incisions on either side of the heel. This allows the surgeon to visualize the plantar fascia on a video screen in real time. The band of tissue is released, and freed from its attachment at the heel, reducing symptoms. The advantage of the EPF is that only the fascia is cut - this eliminates post-op pain and complications. Also, since it is minimally invasive, most patients are in tennis shoes again by the 3rd or 4th day after surgery.
The surgeon may warrant that the spur must be removed along with release of the tension on the plantar fascia. In this procedure, the incision is made on the heel at the instep (5-6mm). The patient is placed in a splint and compression dressing for five days. A change to a bandaid is made at that time. The stitch is removed one week later and the bandaid is continued an additional 3-5 days thereafter.
It must be remembered that not everyone is a surgical candidate, and this problem is extremely successful treated conservatively. A full podiatric history and physical exam is essential in the successful treatment of this common foot ailment.
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