What
causes heel pain?
One of
the most common causes of heel pain is plantar fasciitis or heel
spur syndrome.Other
causes include gout, arthritis, broken heel bone, infection, foreign
bodies (such as stepping on a needle). Your podiatrist can determine
the exact cause of your heel pain.
What
is plantar fasciitis or heel spur syndrome?
Plantar
fasciitis is due to a tight tendon located under the arch and attached to
the bottom of the heel. It has become strained and inflamed, often due to
a lack of proper support, or due to an injury, or overuse. Over time, the
tendon may begin to pull away from its attachment at the heel and a bone
spur develops. Generally, the problem is not due to the heel spur, it is
due to the inflamed tendon.
How do I know if I have plantar fasciitis?
Usually, you will experience pain at the bottom of the heel,
particularly when getting out of bed in the morning or when starting to
walk following a period of rest. It tends to feel better after a moderate
amount of walking. It may not hurt during a workout but usually hurts more the next day
following the workout.
What can I do at home to relieve the pain of plantar
fasciitis?
Applying ice to the tender area for short periods may help. Also, try
gentle calf stretches. Aspirin may relieve the inflammation. Elevating the
heel by putting a soft pad in the shoe under your sore heel may help.
Women may feel better in a shoe with a higher heel.
What if my heel still
hurts?
It's time to see a podiatrist.
What will the podiatrist do?
The key to relief is to reduce the inflammation and pulling of the
tendon at the heel bone. The inflammation may be relieved by anti-inflammatory medicine,
physiotherapy such as ultrasound, or a cortisone injection. The pulling of the tendon can be improved temporarily by supporting the
arch with adhesive tapings. More long term relief may be obtained by the
use of specialized shoe inlays called orthotics. They improve the
mechanics of the foot and relax the plantar fascia tendon.
I've tried medicine, cortisone, ice, rest, orthotics etc.
and I'm losing hope. What else can be done?
When conservative treatments fail, we consider surgically releasing the
tight tendon at its attachment at the heel bone. The procedure can be
performed under local anaesthetic using a small instrument called an
endoscope. The procedure is called endoscopic plantar fasciotomy.
What is endoscopic plantar fasciotomy?
Under local anaesthetic, a small opening is made on either side of the
heel. Through one opening, the endoscope or scope is inserted. The scope
is attached to a small camera to allow the podiatrist to see the inflamed
tendon on a television monitor. Through the other opening, small tools are
used to make a tiny cut in the tendon. This allows the tendon to lengthen,
relax, and relieve the tension on the heel bone or heel spur. Thus, the
pain is relieved. It is usually not necessary to remove the spur.
What are the advantages of endoscopic plantar fasciotomy
compared to conventional hospital heel surgery?
1) Endoscopic plantar fasciotomy uses specialized instruments,
including a small scope and camera, so that the work can be done through
two very small openings in the skin. Consequently, there is less soft
tissue work and less post-operative discomfort.
2) The procedure can be performed painlessly, under local anaesthetic
in the comfort of a podiatry office. You can read a magazine, listen to
music or watch T.V. while the work is done.
3) Expensive hospital beds are not necessary. This results in
substantial savings to the governmental and medical plans.
4) Most people can return to work sooner with this procedure compared
to conventional surgery.
How soon can I return to
work following endoscopic plantar
fasciotomy?
If you sit most of the day at work, you may return within a week. If
you stand all day, you need approximately four to six weeks.
What other foot problems do you
treat?
In addition to heel and arch pain using endoscopic plantar fasciotomy,
I treat bunions, hammertoes, corns and callouses using the minimal
incision technique. I also treat warts and ingrown nails using the carbon dioxide laser. All procedures are performed under local anaesthetic in the comfort of
my office.
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