Diane’s mom did not have believe quite what she was seeing. Diane was a brand new
mom and her mother was visiting in the early weeks to supply a little moral support. Two
or three times a night (sometimes more) she saw Diane hopping on one foot to her
baby’s room to either answer a cry or to just check on her new baby. What
Diane’s mom was witnessing was what we might call the heel pain hop.
Typically heel and arch pain hurt the most with the first few steps in the morning.
After a few dozen steps it eases a bit, but the first few steps are quite painful. If you
have heel pain you probably get up only once. If you are a new mom you are not so lucky.
You might have a half dozen mornings each night. You can either deal with the pain
each time you get up, or choose Diane’s solution.
The culprit in heel pain is a ligament that stretches from the toes to the heel. It is
called the plantar fascia. If you stretch your foot you can actually feel the fibers of
this ligament stretch across the arch. If your foot tends to flatten just a bit, it places
quite a pull on this ligament. If fibers of the ligament become inflamed the problem is
called plantar fasciitis. Sometimes the pull is so great that a spur forms on the heel
bone where the ligament attaches. Because it is so difficult to separate the ligament pain
from heel spur pain they are lumped together in medical speak to heel spur plantar
fasciitis syndrome.
When people experience this syndrome they often turn to medications to reduce the pain.
Pain killers and anti-inflammations can reduce the pain, but at a price. That price is
further stretching of the ligament when you return to activities that were previously
painful. This can create a greater problem once the medication wears off. Real therapy is
directed at reducing the stretching of the ligament.
There are two remedies people with heel pain can try at home. First elevate the heels.
Strange as it may seem, if Diane wore 2-3 inch heels at night she would have less pain.
Actually, that may not be any stranger than hopping on one foot. Guys can achieve the same
effect with cowboy boots.
The next step is to get an arch support from a drug or sporting goods store. Sometimes
these simple and inexpensive devices are effective in reducing heel pain as long as they
are worn every time you walk. Quite often, however, they are not enough.
When you finally make an appointment with your foot doctor, x-rays will usually be
taken. With the x-rays you can see if there is a stress fracture, bone cyst or other
unusual cause of heel pain. If all that is seen in a spur, then you can proceed with
conventional treatment.
In my office I will usually apply a special tape strapping to keep your plantar fascia
from stretching. Usually this causes a dramatic and immediate reduction in symptoms –
much more than the simple arch supports. If it helps then I might suggest that we make a
custom foot support, called an orthotic, to get and keep you pain free.
Sometimes I need to resort to additional therapy including oral anti-inflammatory
medications, cortisone injections, physical therapy or a night splint. A night splint, as
the name implies, keeps the Achilles’ tendon and plantar fascia stretched all night
long. For some resistant heel pain patients, this remedy "turns the corner" and
they become pain free.
Only when these treatments fail do I resort to surgery. My guess is that I do surgery
on only one in a hundred heel pain patients. When surgery is needed I offer one that can
be done in the office, using only local anesthesia and allows patients to walk the very
same day. This micro-incision heel surgery has had a great track record in the
dozen, or so, patients upon whom I have performed the procedure.
For Diane, I taped her twice a week until she got her orthotics. I am happy to report
that mother and child are doing fine and grandma is no longer awakened by an odd pounding
sound coming from the upstairs hallway.
