HEEL PAIN

Heel pain is the most common complaint I get in my practice. The pain can be anywhere in the bottom portion of the heel area or sometimes around the periphery of the heel. It can be described as aching or burning or sharp pain.

The pain becomes most noticeable when first rising after having rested for awhile. It may hurt when you get out of bed in the morning or it may hurt when you stand after sitting for awhile. The pain usually lessens or goes away after standing and walking for a few minutes. As the condition gets worse the pain may become constant.

This condition is known as plantar fasciitis. It is also commonly called heel spur syndrome. Heel spur syndrome and plantar fasciitis are the same condition. The pain is caused by too much traction on a ligament known as the plantar fascia.

The plantar fascia is a very thick, strong ligament that extends from the forefoot to the heel. The key to relieving the pain of plantar fasciitis is to eliminate excess traction upon this ligament. This can be achieved in two ways.

Properly prescribed and fabricated orthotics usually reduce traction upon this ligament enough to provide relief of symptoms. Surgical release of the ligament from its attachment to the heel bone eliminates traction upon this structure.

This surgery is the most certain method of providing relief of plantar fasciitis symptoms but will almost certainly result in other painful symptoms over time.

THE FACTS: SHORT AND SIMPLE

As a general rule exercises, stretches, night splints, anti-inflammatories, injections, magnets, herbs, ultrasound, healing touch, reflexology, rest, ice, elevation, compression, cushioning insoles, heel cups, massage, laser, electrical stimulation, acupuncture, etc. will not provide long term relief of the symptoms of plantar fasciitis.

I call this a general rule because there will always be the odd exception to every rule. For each one of those treatment options I have mentioned there will be at least one person in North America that will attest to the effectiveness of that treatment.

Realistically there are two treatment options that have a very high success rate in treating plantar fasciitis. The most effective conservative treatment is prescription orthotics. These devices re-align the joints of the lower extremity and reduce traction upon the plantar fascia.

The most effective non-conservative treatment is surgical release of the plantar fascia. The ligament is cut so it no longer connects the forefoot to the heel. This eliminates traction upon the plantar fascia but it can lead to other irreversible painful conditions of the lower extremity. Surgical treatment should not be undertaken unless prescription orthotics have failed to provide adequate relief of symptoms.

CAUTION
Prescription orthotics are partially or totally reimbursed by most extended medical insurance plans. You should check your individual plan to see if you will be reimbursed. Most plans have a time lapse clause which applies to reimbursement for prescription orthotics. Some plans will reimburse for orthotics once per year.

Most plans have extended that period to once every two, three, or four years and some have adopted a policy of reimbursement for a pair of orthotics only once per lifetime. Try to make the right choice the first time when deciding on an orthotics provider.

Orthotics fabricated from a strong, light material such as polypropylene, fiberglass, or graphite will maintain their original prescription and strength indefinitely under normal circumstances.

"Dr. Bell cured my heel pain."
Stan Chung, 40, active tennis player