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Heel Pain - When is it not plantar fasciitis?

Heel pain

Heel Pain – When is it not plantar fasciitis?

The most common cause of heel pain is plantar fasciitis.  The plantar fascia is the ligament that starts on the bottom of the heel bone, spans the arch and attaches to the ball of the foot.  It can become inflamed due to overuse, poor unsupportive shoegear or biomechanical issues such as overpronation (foot rolling in too much), oversupination (foot rolling out too much) or a tight Achilles tendon.

Patients with plantar fasciitis often feel what is called “first step pain,” which is pain experienced when the foot is first placed on the floor after getting out of bed in the morning or activity after rest.

Plantar fasciitis from overuse can often go away with rest, stretching, ice, anti-inflammatory medicines and changes of shoegear.  If pain persists or becomes chronic, then there is likely a biomechanical issue that need be identified and addressed.   We are experts in the biomechanics of the foot and ankle.

Our bodies are designed to deal with acute inflammation but not well adapted to chronic inflammation.  Chronic inflammation in arteries can lead to narrowing or atherosclerosis.  Chronic inflammation of tendons and ligaments can lead to thickening and degeneration.

Chronic inflammation of the plantar fascia can cause plantar fasciitis to evolve into plantar fasciosis.  Fasciitis is an inflammatory process.  Fasciosis is a degenerative process.  Treatments for plantar fasciitis do not work for plantar fasciosis.  Treatments for plantar fasciosis do not work for plantar fasciitis.  So getting the right diagnosis is essential.   Use of diagnostic ultrasound to examine the plantar fascia can, within minutes, tell us if we are looking at acute plantar fasciitis, chronic plantar fasciitis or plantar fasciosis.   https://sanantoniopodiatrist.typepad.com/my-blog/2010/01/heel-pain-getting-the-proper-diagnosis.html

Plantar fasciosis need be treated with modalities that induce the body to remove the diseased tissue and replace it with normal fascia, types of regenerative medicine.  ESWT or extracorporeal shockwave therapy was the first such technology.    It is safe, noninvasive and has better than a 20 year tract record of success. https://sanantoniopodiatrist.typepad.com/my-blog/2013/05/eswt-or-extracorporeal-shockwave-therapy-for-the-treatment-of-heel-pain.html

Other treatments for fasciosis include the Topaz procedure, http://www.topazprocedure.com,  Tenex TX https://sanantoniopodiatrist.typepad.com/my-blog/2014/06/tenex-tx-procedure-a-new-minimally-invasive-option-for-treatment-of-heel-pain.html and Tenjet https://sanantoniopodiatrist.typepad.com/my-blog/2018/03/how-to-wash-away-heel-pain-with-water.html

Heel pain that does not involve first step pain, gets worse as the day goes on, may be present at night may be due to Baxter’s neuritis.  https://sanantoniopodiatrist.typepad.com/my-blog/2012/04/baxters-neuritis-a-common-cause-of-heel-pain.html       The inferior calcaneal nerve, more commonly called Baxter’s nerve is a nerve that runs in between the heel bone and fascia.   Symptoms can often mimic plantar fasciitis but an ultrasound exam often shows normal fascia.   This nerve was discovered by Donald Baxter MD of Houston who also developed a surgical procedure to treat it known as the Baxter’s nerve release.   Better than 75 percent of cases do get better with nonsurgical treatment in our experience.  Use of radiofrequency therapy involves the application of heat to the nerve to desensitize it and can be performed in the office.

 

 

Author
Ed Davis DPM Dr. Ed Davis is a Board Certified Podiatrist with over 30 years of experience treating all foot and ankle problems from birth to age 100.

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