Heel pain is one of the most common diagnosis that we see in our practice. Heel pain is often due to an inflamed ligament on the bottom of the foot called the plantar fascia. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst.
Because there are several potential causes, it is important to have heel pain properly diagnosed. As foot specialists we are able to distinguish between all the possibilities and determine the underlying source of your heel pain.
What Is Plantar Fasciitis?
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.
The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.
Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is typically found when one’s job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.
People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.
To diagnose the type of heel pain that you suffer from our staff will obtain your medical history and examine your foot. Throughout this process our foot specialists will rule out all the possible causes for your heel pain other than plantar fasciitis.
In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.
- Stretching exercises
- Avoid going barefoot.
- Limit activities.
- Shoe modifications.
If you still have pain after several weeks, our foot specialists, will add one or more of these treatment approaches:
- Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
- Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis
- Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
- Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
- Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
- Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
When Is Surgery Needed?
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Our foot specialists will discuss the surgical options with you and determine which approach would be most beneficial for you.
No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
Calcaneal Apophysitis (Growth plate injury of Heel)
Minimally invasive surgical procedures for Chronic plantar fasciitis
Our foot specialists have been performing the Topaz procedure since 2006. Originally, the procedure required an incision. The procedure is an outpatient surgery under mild sedation and local anesthesia. A series of needle holes are made into the plantar fascia region of pain and the Topaz probe is inserted and used to break up the scar tissue through a large burst of heat and energy. The micro fascia releases break up the scar tissue and release the fascia in a microscopic level that allows for healing and less pull of the fascia on the heel. This is what we refer to as a micro plantar fascia release. No sutures are required.Recovery is about 4-6 weeks. Patient's are placed in a boot for one week and then sneaker one week after the procedure. Physical therapy may be necessary to decrease pain and help with healing.
2) Instep plantar fasciotomy
The in-step plantar fascia release is used in cases of a severely tight plantar fascia that has pain associated with the heel and possibly the arch region. An instep arch plantar fascia release allows release of the fascia in the tightest region and the incision is made in a non-weight-bearing region of the foot. The procedure is done in outpatient hospital or surgery center under sedation. An incision is placed in the arch region and the fascia is released in its arch side only. The outer side of the fascia is left intact to support the outside portion of the foot while the arch portion, which is normally tight, is released. The patient is allowed to put weight on the foot right after surgery in a boot and is kept in the boot for about 3-4 weeks. Return to full activity, which is expected to take 6-8 weeks in total from the time of surgery.
3) PRP (Soon to come)
4) Tenex Procedure
The Tenex procedure is a minimally invasive procedure to remove the scar tissue and increase blood supply in the plantar fascia. In cases of severe plantar fasciitis, there is chronic scar tissue in the heel region. The Tenex procedure uses an ultrasound wave and a patented suction device to break up and pull out the scar tissue in the plantar fascia. The procedure is performed in the office under local anesthesia or in the surgery center with mild sedation, if the patient prefers. A small needle hole is made on the side of the heel and the probe is introduced into the scar tissue area under ultrasound guidance for precise placement. The scar tissue is broken up and suctioned out of the heel area. The foot is placed in a boot and protected for 1-2 weeks. Usually the heel pain takes about 4 weeks to resolve. Our foot specialists are looking into this new state of the art surgical procedure for chronic plantar fasciitis cases.
Plantar fasciitis or achilles tendonitis, an inflammation, irritation and swelling of the tendon, comes from an injury or doing the things you love or need to doâ€”over and over again. Repetitive motions, no matter how ordinary, can cause small micro tears that occur each time you use your tendon. When the micro tears do not heal properly, tendinosis (tendon degeneration) can occur.
Percutaneous tenotomy or percutaneous fasciotomy, using ultrasonic energy powered by the Tenex Health System, is a safe and quick procedure specially designed for those who are suffering from painful conditions associated with chronic tendon damage. The procedure treats tendinosis or fasciitis in the ankle and foot.
Tenex Health TX is based on advanced technology developed in collaboration with the world-renowned Mayo Clinic.
Tenex Health Benefits
If you have tried physical therapy, cortisone injections, medication, or just taking time to ice, stretch, and rest and are still in pain, talk to us. We now have a solution that does not involve general or open surgery, may give you quick pain reduction and should have you back to enjoying the things you love in a few weeks to a few months.
Patient benefits may include:
- Quick pain relief
- Rapid return to normal activities
- Local anesthetic used instead of general anesthesia
- No sutures, no stitches (requires only a small, adhesive bandage)
- 20-minute, minimally invasive procedure (not open surgery)
- Coverage by most insurances
How does Tenex Health Work?
Precisely targets your damaged tissue. Your doctor uses ultrasound imaging, just like the kind used to see babies in the womb, to visualize and identify the specific location of the damaged tendon tissue.
Gently removes damaged tissue. Once the source of your tendon pain is identified, your doctor numbs the area with a local anesthetic, allowing you to stay awake the entire time. Many people say after the numbing processâ€”which feels like a bee stingâ€”they felt only a slight pressure during the procedure (if they felt anything at all). Your doctor then uses gentle ultrasonic energy designed to safely breakdown and remove the damaged tissue. The ultrasonic energy is applied with the TX MicroTip, which requires only a microincision to reach the damaged tissue. Because the incision is so small and the ultrasonic energy precisely treats only the damaged tendon tissue, the surrounding healthy tissue is left unharmed.
Requires no stitches. When the procedure is completed, your doctor applies a small adhesive bandage; no stitches are required. Because you are awake during the procedure (no general anesthesia), many people are able to drive home after the procedure.
Can offer nearly instant pain relief with a rapid recovery. Recovery is rapid with many people being back to normal activity within 6 weeks or less. Because the surrounding healthy tissue is not disturbed, and no stitches or general anesthesia is required, there is minimal downtime and less discomfort compared to open surgery. The speed of your recovery depends on the location of your tendinitis and your individual results may vary.
What areas of the body does our practice treat with Tenex Health?
VIDEO: Learn more about Tenex Health
As a percutaneous tenotomy or percutaneous fasciotomy procedure, Tenex Health TX is typically covered by Medicare-approved and private health insurers. It is always recommended that patients consult the treating physician and individual health plan. For more information, visit www.tenexhealth.com.