Heel pain, arch pain, heel spur or plantar fasciitis
One of the most common foot problems encountered is a painful heel and arch. This pain is caused by what is known as Plantar Fasciitis. Plantar Fasciitis is caused by an excessive pull on the ligament of the arch (Plantar Fascia), which results in inflammation. The Plantar Fascia is a continuation of the Achilles tendon (large tendon of the calf muscles) as it inserts on the back of the heel and wraps around underneath the foot and arch. In many individuals, the arch of the foot collapses causing excessive pull on the Plantar Fascia. The body responds with inflammation, leading to pain.
A common misconception is the cause of pain. Many believe that the “heel spur” is the source of heel pain. This is FALSE. The spur itself rarely causes pain, but is a manifestation of the body responding to the excessive pull of the fascia on the heel bone. As the Plantar Fascia pulls harder on the bottom of the heel bone, it slowly grows out onto the fascia. The pain that is felt is due to both the significant inflammation to the fascia and the excessive pull on the fascia itself.
Heel pain is commonly a clinical diagnosis based on the history and physical exam. X-rays are often taken to rule out fractures and other bone problems and visualize if a spur is present. Ultrasound imaging can also be used to visualize a change in thickness of the Plantar Fascia.
In 4-6 weeks of simple treatment, most heel pain patients feel 90-95% better. Conservative treatment consists of stretching exercises, good supportive shoes, arch supports and anti-inflammatories. One of the more effective ways of getting anti-inflammatory medicine to the plantar fasciitis is via cortisone injections. Cortisone is a very strong anti-inflammatory.
For a smaller percentage of patients, foot surgery for plantar fasciitis is required. Traditionally, plantar fasciitis surgery involved a small incision about the heel through which the plantar fascia was identified and released from the heel bone. In the case of heel spurs, the painless spur then filed down. This surgery for heel pain left the plantar fascia functionally longer than before the surgery, thus releasing the tension and tightness to the plantar fascia. This is an outpatient foot surgery taking less than 45 minutes. Patients are able to walk in a walking boot for 2-4 weeks and can begin feeling significant improvement in that time.
Dr. Marcin N. Vaclaw is one of the pioneers of a “no-incision” plantar fasciitis surgery involving stem cells. This foot surgery is minimally invasive, takes 10-15 minutes and allows (and encourages) the patients to walk on the foot the same day as surgery without any boot or protective device! The patients begin feeling improvement within a few short weeks and can continue to benefit from the procedure for a long time.
Endoscopic Plantar Fasciotomy can also be performed for plantar fasciitis. An endoscope or “scope” can be inserted to visualize the plantar fascia before releasing it. As with the “no-incision” surgery, patients can bear weight immediately after surgery and generally have very little post operative pain.
At FAS The Woodlands, the diagnosis and treatment of heel pain is offered to patients in a stepwise approach. A variety of options exist to help alleviate the pain caused by plantar fasciitis. The majority of heel pain patients find relief by following our initial non-surgical treatment plan, keeping you “A Step Ahead.”
For painful achilles heel spurs the conservative treatment is similar to plantar fasciitis. Stretching and anti-inflammatories provide the best non-surgical treatment. When necessary, achilles tendon surgery can be performed to release the tension on achilles tendon as it inserts to the heel. The spurs associated with the achilles tendon can be painful as shoes often press tightly upon them. Achilles spur surgery involves releasing the tendon from the heel bone and filing down the prominent spur. Dr. Marcin N. Vaclaw has also pioneered a technique involving a “no-incision” achilles surgery utilizing stem cells.