As I woke up this morning to my NPR (National Public Radio) alarm clock, I heard they were doing a story on plantar fasciitis (pain in the heel or bottom of the foot). My ears perked up because I treat many people with this problem and only get good results about 90% of the time. Another 5-8% get some improvement but still have pain and a few I don’t seem to be able to help at all!
I was interested to hear that it’s estimated that about 33% of older (over 45) adults have trouble with foot pain. Proper foot wear and custom orthodic foot supports were discussed, pretty much as I use them in my practice.
What I found especially interesting was a new treatment called “Shock Wave Therapy”. This uses a device that generates powerful sound waves to pound on the heel “like a little baseball bat”. The foot has to be numbed with novocaine first which gives us an idea of how hard the heel is being hit. The theory is that, by injuring the foot, the shock wave therapy will stimulate a healing response that may heal the original problem. The cost was quoted as being from five hundred to several thousand dollars. I was thinking that this sounded pretty extreme! Then the story went on to state that up to 25% of shock wave therapy patients experienced complete pain relief.
I’m always amazed when there is excitement over this kind of results. If I only got resolution with 25% of my patients (plantar faciitis or anything else) I’d be pretty upset and start looking for something that worked better!
The story continued, stating that podiatrists used to think that plantar fasciitis was caused by heel spurs (actually, in my opinion, heel spurs are the result of chronic plantar fasciitis that has not been resolved) or inflammation but not anymore. Surgery often made people worse so is not used much anymore (thank goodness!).
The story concluded with the observation that the cause of plantar fasciitis is not clear but that many people eventually got over it.
At this point I started feeling even better about my results with plantar fasciitis. As I said, I get complete resolution of pain and symptoms with 85-90% of my patients with some improvement in most of the rest. I have a pretty good idea about the cause, which is probably why I get such good results.
The job of the plantar fascia is to help support the longitudinal arch of the foot. There are also muscles that help in this process. I see plantar faciitis occur when either the bones that plantar fascia attach to misalign, putting abnormal pressure on the fascia or when the supporting muscles turn off, leaving the fascia to do all the work, or both.
In most cases, realigning the bones and getting the supporting muscles to stay turned on takes pressure off the plantar fascia and allow it to heal. Proper footwear is important to provide support (women’s shoe fashions are often big offenders). Fortunately I can test to see if your shoes are stressing your feet, legs or back. Sometimes I need to cast patients feet for custom orthodics or use specific nutrition or laser therapy to get the best results. Other factors such as being more than 50 lbs overweight or ergonomic (work conditions) may also play a roll.
In the past, I haven’t talked much about plantar fasciitis, I have just treated it and moved on. After hearing this story however, I thought I needed to speak up and let folks know that there are more successful, less expensive methods to resolve this common problem than pounding your heels “with a little baseball bat”!
As always, questions and comments can be sent to me at: drhogg@drhogg.com or call me at 563-386-9494
