March 30, 2018

Common Ailments As Seen By the Podiatric Surgeon

Quiz: It is estimated that 2 million people complain of this condition each year and yet only 1 in 4 visits a specialist.

Give up? It’s heel pain.

The specialized soft tissue of the heel functions as a shock absorber for the foot during any activity. The heel can absorb 110 percent of the body’s weight during walking and 200 percent of the body’s weight during running.

Despite this impressive strength, the tissues in the heel region can become inflamed. With an ever-

increasing active population, day-to-day activities and an increase in BMI or relative bodyweight, the potential for pain and inflammation at the heel have become a common entity.

Most of the time, of the condition of heel pain is from overuse; in particular, the inflammation of the tendon that runs from the heel to the ball the foot. Like a string on a bow, this tendon flexes with each step but overuse or inadequate padding or shoe gear can rapidly progress the formation of plantar fasciitis.

Plantar fasciitis is essentially a form of tendinitis in the foot where the structure is inflamed. Without proper attention, this can become a chronic condition. If left untreated for a long period of time, the average thickness of the tendon can double in size from the swelling and inflammation.

A typical patient will have heel pain for a number of weeks to a number of months without any other associated incident that the patient can correlate to heel pain or its surrounding area of symptoms. When seen, a patient usually reports moderate to severe pain upon their first steps in the morning, which subside after a short period, but increases throughout the day with excessive or increased use.

An initial consultation will include the examination of the heel structure and the plantar fascia tissue, along with possible X-rays which may or may not show bone spur formation. Bone spur formation is a secondary reaction to inflammation in the heel bone itself from the localized plantar fasciitis.

Conservative measures of treatment would be supportive shoes that provide shock absorption, such as sneakers, and whether or not insoles or anti-inflammatories such as Motrin or ice therapy can help with the symptoms presented by the patient. If not, it is very common to begin treatment with a corticosteroid injection. This is done with a long-acting local anesthesia to relieve the inflammation at the junction of the heel and the plantar fascia. This requires a simple Band-Aid and does not restrict activity at all; the patient can walk out comfortably and drive home.

Additional treatment options for more severe cases could involve a stronger anti-inflammatory medication by prescription, a walking cast, or potentially physical therapy. Less than 20 percent of patients would not respond to these treatment courses and would, therefore, require surgical intervention. Additionally, to augment or maintain relief in the heel, a podiatry office commonly does prescription molding for orthotics.

Dr. Richard Manolian is a board-certified podiatrist with Harrington Physician Services. He received his medical degree from the California College of Podiatric Medicine in San Francisco and completed a residency at University Hospital in Boston. He is also board certified in foot and ankle surgery. To reach his office for an appointment, call (508) 764-2442.