More Americans visit a foot and ankle specialist for heel pain yearly than for any other foot complaint. Why ? Its simple – we walk, run, stand, climb, jump on a hard unforgiving surface everyday with our feet taking the abuse. The heel strikes the ground first and absorbs all of our weight thousands of times a day. When heel pain occurs to the average person they don’t rush off to the doctor first – they often go to buy over the counter remedies from their local pharmacy. But when those remedies fail they seek out medical care. Historically medical care offered as a first line of treatment :
- Stretching exercises
- Custom orthotics (foot inserts)
- Cortisone injections
- Strapping of the foot with tape
Approximately 80% of all heel pain patients had their pain resolve but this left 20% with pain that interfered with their daily lives and jobs. For the 20% of patients who had no relief, our podiatry office offers advanced heel pain treatments that work. First, we need a simple explanation of why heel pain exists. The foot has a broad tissue called the plantar fascia on the bottom of the heel that connects forward to the toe joints. It acts like a trampoline. If you have tightness in the back of your leg muscles it will affect this fascia. If you pronate or have flat feet it will affect this fascia. The fascia will become inflamed, painful and thickened at the heel and the surrounding nerves will report to the brain via the peripheral nerve system that you have a problem. Large heel spurs or bone growths occur because the fascia chronically pulls away from the bone creating an inflammatory process whereby bone is produced. The greater the pulling over time, the larger a heel spur is produced.
Additionally certain types of arthritis can produce heel pain: Rheumatoid arthritis, Systemic Lupus, and Reiter’s disease. Several nerves pass through the area of the heel providing sensation to the sides and bottom of the heel. Sometimes these nerves become entrapped and produce heel pain symptoms. A proper examination of the heel is required to determine which treatment option will work the best to relieving the heel pain. Using the newest digital ultrasound diagnostic unit we can now see not only the bones of the foot but the tendons, ligaments, arteries, veins, nerves and muscles as clearly as a picture on your cell phones. Nerve testing is performed for those patients with heel pain of neuritic origin. Once a diagnosis is determined a treatment plan will be reviewed in detail with you.
NEW TREATMENTS THAT WORK – OFFER PATIENTS THE RELIEF OF HEEL PAIN.
- Radiofrequency Lesioning is a treatment protocol that I co-authored the original published article in 1996. Since then this procedure has been widely accepted and performed with a 88-92% success rate. Patients can literally walk out in their own shoes right after the procedure.
- Percutaneous Needling Fasciotomy is a treatment protocol that uses a needle to provide relief from heel pain. Patients again can walk out in their own shoes right after the procedure.
- Digital Ultrasound Guided PRP injections allows a patients own blood platelets to be re-injected around the patients heel to allow healing of the plantar fascia.
- Digital Ultrasound Guided Amniotic Tissue Graft injection places Stem Cells from Amniotic Tissue to regenerate the plantar fascia.
- Endoscopic Plantar Fasciotomy is a surgical procedure that utilizes a small 5 mm incision to allow entry of a 4mm camera such that we can actually see the plantar fascia and then lengthen it. This procedure usually requires 10-15 minutes.
If during the course of the patient’s examination an impinged or damaged nerve was found to be the true cause of the heel pain then treatment options for the release and repair of the nerve would be offered. Many times patients have undergone treatments and surgery by another physician with failed results leading to worsening of the heel pain. Usually the diagnosis of nerve entrapment was missed initially and complicated by the wrong procedures being performed.
Dr. Paul Klein is a Board Certified Foot & Ankle specialist with Fellowship training in Peripheral Nerve Surgery with over 40 years of experience. Dr. Klein is a national lecturer on nerve pain and its treatments; and is past Division Chief for Podiatric Surgery at St. Joseph’s Wayne Hospital.
Dr. Klein has successfully performed countless numbers of nerve releases for heel pain with patients returning to pain free and normal lives. If you or a friend has heel pain that has not been relieved by over the counter products or has experienced less than optimal results from prior medical care than call Dr. Paul Klein at 973-595-1555