Archive for November, 2011

Treating Heel Pain: Heel Spurs

November 29th, 2011 by Dr.Chang

Plantar fasciitis is sometimes called, “heel spur syndrome,” as heel spurs often accompany it. But the two are not to be confused; heel spurs and plantar fasciitis often come hand-in-hand, but they are not the same injury. While plantar fasciits is inflammation of the plantar fascia tissue, a heel spur is a hook of bone that can form on the heel bone, which will show up on an X-ray. Those with a history of heel pain are often at a higher risk for heel spurs. Since the heel spur hooks that form on the bone are often at the base of the plantar fascia, it is clear why the two conditions are often related.

Your podiatrist will recommend a similar treatment plan for heel spurs as for plantar fasciiits. First, avoiding activities that aggravate your heel pain should be avoided. Resting from stressful exercise and training does not mean inactivity – in fact, engaging in non-stressful activity such as swimming can help speed the recovery process. The main goal of rest will be to reduce the inflammation in your heel, thus lessening the pain you feel.  Applying heat and ice packs as well as taking NSAIDs (non-steroidal anti-inflammatory drugs like Ibuprofen) will also aid in reducing the swelling and therefore the pain. Your podiatrist will recommend strengthening exercises and stretches that will work to relax the muscles surrounding the calcaneus, or heel bone. Patients often report quick results when they diligently stick with these exercises.

It may help to reexamine your shoes, or to use shoe inserts, heel pads, or over the counter or custom orthotics Be sure that you consider your every-day shoe wear along with your athletic shoe wear, as both standing for long periods of time as well as exercise can stress your heel.

Finally, night splints will help you stretch your heel when you sleep, preventing morning pain when you take your first few steps out of bed. . Dr. Murray and Dr. Chang sell a variety of night splints that you can find here.

In extreme cases, and only after a year of trying other treatment options, your podiatrist may suggest more invasive treatment therapies. These include the new extracorporeal shock wave therapy (ESWT), corticosteroid injections and surgery.

Pain from heel spurs often reoccurs. However, staying dedicated to your stretching and strengthening exercises as well as wearing proper and supportive footwear is a good step to preventing the reoccurrence of heel spur pain.

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Treating Heel Pain: Plantar Fasciitis

November 14th, 2011 by Dr.Chang

By far, the most common cause of heel pain, plantar fasciitis, is inflammation of the plantar fascia, the tendon that runs along the bottom of your foot and around your heel.  The plantar fascia tissue contributes to supporting the arch in the foot and distributing body weight across the foot. The plantar fascia bears up to 14% of the pressure exerted on the foot. When the plantar fascia becomes inflamed, doctors term the condition plantar fasciitis. Plantar fasciitis is often associated with abnormalities of the foot’s structure, such as high arches (pes cavus) and flat feet. Environmental factors can also cause plantar fasciitis – whether running on pavement or in worn out shoes, running long distances or increasing our training too quickly, or even by experiencing sudden weight gain, we can put undue strain on our plantar fascia.

For an effective plantar fasciiits treatment strategy, first consult Dr. Murray and Dr. Changto target the causes of your injury. Many treatment strategies exist for plantar fasciitis, but the treatment plan that you adopt should be specific to your individual injury. Do you have flat feet, and therefore would benefit from wearing orthotics, supportive shoes and doing foot-strengthening exercises? Do you have a heel spur that is causing your plantar fasciitis? Have you increased your training too rapidly, in which case you should take some rest days until the inflammation and pain recede and then reconsider how you ramp up your training plan? And what about the surfaces that you are regularly running on? Your everyday footwear? Lifestyle changes such as sudden weight gain? Do you have other possible conditions, deformities of the foot, or injuries to which your plantar fascia may be responding? In short, there is no one-way to treat plantar fasciitis. Without considering the cause of your own injury, it is unlikely that you will heal from it without reoccurrence.

After diagnosing you with Plantar Fasciitis, your podiatrist will recommend that you temporarily slow down. Being sure not to stand for long periods of time will help your feet heal, and a reduction in activity could include easing up on a range of activities from running to walking in bare feet. Note that resting your plantar fascia does not mean stopping activity and exercise altogether – you may have to identify exercises that don’t aggravate your heel pain, but in general, mild exercise will help strengthen and stretch the muscles in your foot, and increased blood flow to the affected area will help your foot heal. You may want to try swimming, or an easy session on the elliptical. Ask your podiatrist for suggestions on mild stretching and strengthening exercises for the plantar fascia and beyond.

Your podiatrist will also recommend a variety of active treatments. First, you should seek out shoes with arch support for exercise and everyday use. Arch support could come from padding such as heel cups, footpads, shoe inserts and custom made orthotics. Night splints are incredibly effective – these keep the foot flexed and the plantar fascia in its resting position overnight, making it much easier to take the first few steps in the morning. While it may be difficult to get used to sleeping in these night splints, you will feel positive results soon after you begin wearing a night splint, making the initial discomfort well worth the effort!

Heat and ice are great aids to plantar fascia treatment. Applying a warm heating pad to your heel before exercise can relax the muscles, making them looser for exercise. After exercise, icing is recommended to reduce the inflammation and to provide pain relief. Massaging your foot by rolling it on a frozen juice can is a great trick, and will get massage and icing out of the way. Whether you use this trick or kick back to ice your feet, you should adopt a 20 minute/twice a day icing routine to reduce your plantar fascia inflammation. Your doctor may also recommend that you take non-steroidal anti-inflammatory drugs, or NSAIDs, such as Ibuprofen, Advil, Motrin or Aleve. These work by blocking enzymes that stimulate swelling to reduce the pain caused by inflammation. Once you are on the mend, your podiatrist may instruct you with how to support the arch of your foot with athletic tape, a support that may help you ease back into exercising.

In the most severe cases, boot castes may be prescribed, and even steroid shots or injections may be given. If pain continues, in very extreme cases, your podiatric surgeon may suggest surgical methods.

Note that the reoccurrence rate of plantar fasciitis is fairly high. It is easy to feel as though your plantar fascia has recovered, and frustrating when the pain resurfaces the next morning, the next month, or the next year. Note that the reoccurring pain may surprise you when you put weight on the injured foot after resting. In this case, finding a consistent preventative routine may be key for you. In general make sure your ankle, your Achilles tendon and your calf muscles are flexible and strong with stretches and strengthening exercises prescribed by your podiatrist or physical therapist. Be sure that you are not exercising with old, worn-out footwear, and that your day-shoes are supportive and well fitted (in support, size, width and cushioning), to your individual feet.

Most of all, exercise diligence with your plantar fascia care and patience with healing your plantar fasciitis – it will take some time, in some cases up to a year, but these guidelines provide success for most plantar fasciitis sufferers.


Treating Heel Pain Series

November 3rd, 2011 by Dr.Chang

Heel pain is one of the most common reasons that our patients come to see us at Blue Ridge Foot and Ankle Clinic.  Since it is a big concern for so many patients, we have decided to do a blog series on different types of heel pain and how they are treated. We will start with this post on the general treatment of heel pain and then starting next week we will cover one specific type of heel pain & a treatment plan for it each week.

Between the structural complexity of the heel, its biomechanics and the pressure we put on it when we engage in pretty much any activity, it is clear why the heel is not invincible (as much as we wish it could be!). Most athletes and runners complain of heel pain at one time or another, and it is important that this pain is diagnosed early and accurately for quick and successful recovery. Because of the multiple causes of heel pain, the individual physiology of each foot, and the varying amounts of stress that each person puts on his or her feet, it is important that heel pain is individually diagnosed and a treatment plans are individually tailored. Consult Dr. Murray and Dr. Chang for an accurate diagnosis and treatment plan.

To understand the underlying cause of your heel pain, your podiatrist will examine your foot, consider your medical history, and in certain cases conduct diagnostic imaging studies such as X-rays or MRIs.

Treatment may vary or be a combination of surgical and non-surgical methods. Your podiatrist will most likely recommend immediate treatment to comprise of RICE: rest, ice, compression and elevation. Limiting activities is important so that your heel has the proper time to rest and rebuild the impaired tissue. Ice packs should be applied, with a thin towel between the ice and the skin, for twenty minutes at a time, several times a day in order to reduce inflammation in the affected area. Your podiatrist will point you toward the proper wrapping or splinting method for your injury, providing you with a removable walking cast or other forms of immobilization to allow your injury the time, immobilization and support required for it to heal. Lying on the couch with your foot elevated up to 15 inches above your heart is a great way to reduce additional inflammation and swelling.

NSAIDs, or non-steroidal anti-inflammatory drugs, such as Ibuprofen, Aleve and Advil, will block enzymes that stimulate swelling responses in your body, thereby reducing pain. These should be taken as indicated on the packaging label or recommended by your doctor, but always with plenty of water as NSAIDs taken in excess or not properly flushed out of your system can have harmful effects on the kidneys. If NSAIDs fail to work after a number of weeks, your podiatrist may suggest injection therapy, of corticosteroid injections, to help reduce the inflammation in your heel and to relieve pain.

Your podiatrist will most likely recommend other techniques for padding and shoe modifications, and will suggest that you avoid going barefoot as shoes can help you relieve strain from your heel and affected area. Discuss which supportive shoes with good arch supports that are appropriate for your individual foot physiology and injury or condition would be best for you to wear. Your foot doctor will also supply you with and show you how to use padding for your shoes and how to strap or tape the injured area if necessary. Over the counter and custom orthotics are often important for long-term injury prevention, especially if your injury is a result of biomechanical abnormalities (with the way you walk, or your gait, for example). Finally, you can purchase a night splint from Blue Ridge Foot and Ankle, which helps you to stretch your plantar fascia as you sleep, reducing overnight swelling and making the first steps out of bed in the morning less painful.

Non-surgical treatment may include a regimen of exercises that range from stretching to strengthening, and will usually involve work with a physical therapist. You physical therapist will work with you to stretch your calf, which will relieve strain on the affected area and assist with blood flow, which will help you recover faster. Physical therapists may also use massage techniques to increase the blood flow in the affected areas.

If all other treatment methods fail, surgery may be a viable option. Surgical methods depend on your individual condition and its severity. Consult Dr. Murray and Dr. Chang to discuss surgical treatment options.

Heel pain is hard to deal with in the long-term, because the underlying causes that led to your injury may be difficult to resolve. For a runner, the problem may be the miles you are logging, the surfaces on which you are running, your rest schedule, or even a workout that you did weeks ago. It’s possible that your running shoes are worn out, or that the problem is the shoes you wear or activities you pursue outside of running. Plantar fasciitis, for example, can be aggravated by even the most unexpected stresses, such as how you sleep or pressing the clutch in your car.

However, the good news is that most heel injuries are preventable with dedicated work – be sure to wear supportive shoes, always warm up before exercise, cool down and stretch afterward, and most of all, listen to your body. When you experience heel pain, visit Dr. Murray and Dr. Chang of The Heel Pain Center of Central Virginia. With their years of experience working with the Charlottesville and Waynesboro community, they can help you get back on your feet and on the road to recovery.



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