Healing The Heel

It’s not just runners that seek treatment for heel pain

Picture three different people: a high school student on the track team, a senior citizen who enjoys a daily morning walk, and a middle-aged couch potato.  Who among them would you think is most susceptible to heel pain?

It’s a trick question. Heel pain, particularly from a condition called plantar fasciitis, can happen to all three of them.

“Plantar fasciitis does not discriminate,” says David Valbuena, DPM. “It can occur in all different foot types and body types, and within any kind of activity level.”

“We see patients at 16 or 17 years of age all the way up to 80 or 90, and everyone in between,” echoes Keith Rouse, DPM.

Both Dr. Valbuena and Dr. Rouse are podiatrists and board-certified ankle and foot surgeons at Georgia Foot and Ankle Institute, P.C. While they do see a large number of runners, soldiers, and workers who have to stand for long periods of time, they also treat some patients with a sedentary lifestyle for plantar fasciitis. This is because of the nature of the injury.

Wear And Tear

A thick, fibrous band of tissue called the plantar fascia stretches from the heel bone to the middle foot bones, supporting the arch of your foot and providing some shock absorption. Too much repetitive pressure can tear the tissue, causing pain.  But the injury doesn’t always come from running or standing—the strain can also happen after a period of rest.

“The band tightens when you rest, and if that first step in the morning or after being sedentary causes a small tear, and this happens repeatedly, it creates a chronic inflammatory cycle that can be difficult to break,” Valbuena says.

This is why the pain is often the most intense in the morning. It often decreases, but could return with more pressure or after another long period of rest. For some, the pain is debilitating and causes patients to hobble, making things worse for their other foot.

Prevention And Treatment

Dr. Valbuena and Dr. Rouse have several treatment options for plantar fasciitis, but they would rather their patients avoid developing the condition in the first place. Though people cannot change their foot’s anatomy, and may be unable to change their job’s physical requirements, the physicians recommend these preventative steps:

• Wearing proper shoes, with good arch support and a low-to-moderate  heel (replace worn-out shoes regularly)
• Use orthotic inserts for added arch support if needed (Dr. Valbuena and Dr. Rouse can create custom  inserts for patients, depending on severity)
• Stretching before and after athletic activity
• Not going barefoot! Though some might argue that we having been walking barefoot since the dawn of civilization, the fact is that our ancestors did not have to contend with concrete roads and paths and concrete slabs under our homes. Proper shoe gear and support, inside and outside the house, is the smart choice today.

Dr. Valbuena and Dr. Rouse can assist patients with achieving good arch support, and that is among their first line of defense when treating patients, along with stretching.

“We give patients anti-inflammatory medication and, if needed, a cortisone injection to stop that inflammatory cycle,” Dr. Valbuena says.

The physicians say that between 5 and 10 percent of their patients need additional treatment such as surgery. This typically involves the release, or partial cutting, of the plantar fascia from where it connects to the bone to relieve pressure.  As board-certified ankle and foot surgeons, Dr. Rouse and Dr. Valbuena have several methodologies for releasing the fascia, and can determine the best procedure for each individual patient.

Other Causes Of Heel Pain

Posterior heel pain is pain felt behind the heel rather than at the bottom of it. A common source of this kind of heel pain is Achilles tendinitis, an overuse injury of the Achilles tendon. Like the plantar fascia, the Achilles tendon (also known as the calcaneal tendon) is a tough band of fibrous tissue. This band connects the calf muscles to the heel bone. Achilles tendinitis tends to occur mostly in runners and athletes in sports such as tennis or basketball.

Some patients seek treatment for what is known as Haglund’s deformity. This is a basically a bony bump on the back of the heel. When the bump rubs against shoes, the soft tissue near the Achilles tendon can become irritated. Often, this leads to bursitis—a painful inflammation of the bursa, which is a fluid-filled sac between the tendon and the bone.  Haglund’s deformity is commonly found in patients who wear rigid or stiff shoes, but it can develop in anyone.

Whether the problem is on the bottom or the back of your heel, or whether it’s as common as plantar fasciitis or something more rare, Dr. Rouse and Dr. Valbuena are eager to use their specialized training to keep your feet in tiptop shape.

“We serve all foot and ankle needs for every kind of person,” Rouse says. “Just as heel pain can affect many different people at many different stages in life, we are equally ready to treat it.”

Learn more at www.gafootandankle.com.