Dr Marybeth Crane talks about chronic heel pain and the difference between plantar fasciitis (acute) and plantar fasciosis (chronic). Have a listen.....
This is my first attempt at using animation for patient informational videos. Don't laugh too hard :) Send me topics you would like in this media!
Confessions of Myrundoc: Do as I Say, Not as I Do.....
Time to come clean. Yes, I too can fall victim to a running injury. And yes, of course it's a foot related issue. Turns out the old adage is true that doctors are the worst patients, just like plumbers often have leaky pipes at home :) in fact, I think doctors are the worst patients only trumped by pilots. Yes, it's a control issue!
Because I'm the local authority on running injuries I of course started to treat my injury when it was in its mild form....Not! No, I did like most of my patients and ignored it until my foot hurt so bad the day after a race that I could barely out my heel on the ground. Yes, I suffer from the dreaded and incredibly common plantar fasciitis in my left foot. Why? A combination of the perfect storm.
I would like to blame it on the White Rock Marathon, you all remember that glorious day.....45 degrees, pouring rain....but if I'm honest, it started way before that. I ran the DRC Half in November with bronchitis (also a brilliant move) then barely trained the rest of that month as I was getting over my upper respiratory infection. Couple that with an incredibly busy November and December in the office and the OR; you get poor training schedule, exhausted body and depressed immune system. Oh yeah, I also ran the White Rock Half marathon in the pouring rain and had to run the Bold in the Cold Half marathon because my running club was putting it on and the medal was cool.
Long story short, what started as a little tightness at the Phoenix Turkey Trot over Thanksgiving (oh yeah, ran that too, then climbed Camelback Mountain the next day), became a swollen, sore foot by the first weekend in January.
So what do I do? I stopped running. This wasn't really a choice since I could barely put my foot on the ground the day after Bold in the Cold. I started icing, taking Advil and lots of stretching. I looked at my shoes and realized I had five pairs I was working on and all of them were dead. My orthotics were 3 years old and needed replacing. I started wearing nothing but a brand new pair of running shoes to work and clogs on the OR. I even let my partner give me a steroid injection. And I got in the pool and on the elliptical and bike so I didn't gain a million pounds!!
A month went by and I was somewhat better. Maybe 50% but still couldn't run. I was now starting to get annoyed and my staff wanted me to get back to running so I would stop being cranky! Onto EPAT....why have technology if you aren't going to use it? What is EPAT. Yes, I had the EPAT procedure performed the first week in February and yes, it hurts like hell but way worth it. I was about 70% better after the first treatment and 80% after the second. I still did the night splint (incredibly annoying but effective for the first thing in the morning owie), had gotten a brand spanking new pair of custom orthotics and still wearing nothing but running shoes, clogs and a two inch heel when necessary.
I went for my first run in 6 weeks yesterday in Napa Valley, CA. I was in wine country for a conference and my foot was feeling so much better. I did 4 miles of walk run and did pretty well. Tight but not painful! I'm going to have my third EPAT this week and I think that should do it. Maybe I will let the staff video it so you can all join in.
What did I learn? Listen to my own advice. Do as I say, not as I do. If I had started stretching, icing and looked closely at my shoes and orthotics at Thanksgiving; this whole saga probably could have been avoided. Stubbornness and the fact that when I close my eyes I'm 19, did not help me recover.
Thank God for technology! The EPAT certainly saved the day for me. I'm sure two months of physical therapy would've had the same result, but time was short and technology available! Bring on the triathlon season! First race St. Pat's Sprint Tri in Keller on March 10th!
Got Heel Pain? Give me a call!
EPAT is the most advanced non-invasive treatment for musculoskeletal pain. Extracorporeal Pulse Activation Treatment is a new way to conquer chronic heel pain. Pressure waves stimulate the metabolism, enhance circulation and accelerate the healing process without surgery. Dmaged tissue of the plantar fascia or Achilles tendon gradually regenerates and eventually heals. Here are the top 16 frequently asked questions about EPAT.
The Top 16 FAQ’s About EPAT Therapy for Heel Pain
Plantar Fibromatosis. Wow, that's a mouthful! What is it? A lump in your arch that is firm and doesn't move. They usually start out as a very small pea sized nodule that increases in size over time. Most people don't even notice them until they get big enough to be annoying in your shoes or when walking barefoot. They can happen to anyone, but are most commonly seen in middle-aged to older patients and are much more common in men than woman. It is also more common in the Caucasian population than other ethnicities.
Most people come into the office complaining of a painful lump in their arch and are very concerned it is cancer. It is actually just an exuberant growth in the plantar fascia (a.k.a. the ligament that holds up your arch) or extra fibrous tissue. We really don't know why they occur, but it is thought that some kind of trauma plays a role in the formation of the nodules. I often see them in pilots and runners who have constant repetitive trauma to this area. Family history is also a factor. As many as 50% of patient with plantar fibromas also have nodules in the palm of their hands known as Dupuytren's contractures. There has been some correlation with medications like beta-blockers and anti-seizure medications. One study even linked an excessive amount of vitamin C with fibrous disorders. Patients with a history of chronic liver problems, diabetes, seizures and alcohol abuse seem to have a higher rate of plantar fibromas.
Treatments vary, but fall into three categories:
1. Do nothing: the nodules are annoying but usually self-limiting. They do not grow indefinitely, so if you can put them down as life's minor annoyance, most patients choose to just leave them alone.
2. Conservative or Non-invasive: Vigorous stretching, accommodative orthotics, physical therapy, and topical transderamal Verapamil.
3. Surgery: injections with a corticosteroid can be helpful to decrease the inflammation around the nodule, but if they are large and painful; most go on to surgical excision.
What should you do? A personal question, that only you with the help of your doctor can answer. In my opinion, if the nodule is small, leave it alone. If it is increasing in size, then it should be addressed. If the nodule is of moderate size, with no intrasubstance calcifications on x-ray, and is annoying; a three to six month trial of transdermal verapamil coupled with an accommodative orthotic and physical therapy can be helpful. If it meets these criteria and is a little soft, then a steroid injection may also help decrease the size. If the lesion is large, painful, or has intrasubstance calcifications on x-ray; then excision is most likely your best option. Simple excision is not enough with these lesions, removal of not only the lesion, but a large margin is necessary to decrease recurrence rates.
If you have a painful lump in your arch, seek the advice of your podiatrist. Help is only a phone call or mouse-click away!
The Debate Continues....On and On....
They are at it again. The debate that has been going on since the late 1970’s when custom orhtotics became the mainstay of treatment for plantar fasciitis. “Millions in Potential Health Care Savings: Prefab Orthotics Found More Effective” was a press release today from a company that...guess what?…makes an off-the-shelf arch support! Are you kidding me???
Now don’t get me wrong, I think there is a place for prefabricated arch supports in our treatment plans and not everyone needs a custom orthotic; but to say that prefab is BETTER than custom is ludicrous! Let's use common sense! They sited a poor study done in California on patients with plantar fasciitis and then backed it up with a totally flawed study from 1996! That’s all they have??? What about the millions of patients that have been helped by custom orthotics across the country? Several thousands right here in the Dallas/Fort Worth area!
Just another ploy to get patients to potentially waste their money on off-the-shelf inserts prior to visiting their podiatrist! A copay is much cheaper and I am so sick and tired of seeing peolpe waste hundreds of dollars on things they find on-line. Then spend months in physical therapy or even need surgery to try to conquer their plantar fasciitis; when they could have gotten better much faster IF the first thing they did was call the podiatrist!
I’m done venting, but for more information on why custom orthotics work check out my patient information pages.
Got Heel Pain? Check out my new video!
HEEL PAIN (PLANTAR FASCIITIS)
This syndrome is most commonly caused by several factors, including, but not limited to:
-Tight calf muscles
-Increase in body weight
-Sudden change in the amount of intensity of exercise
-Improper or worn out shoes
-Abnormal foot biomechanics (excessive pronation or supination)
Due to any of the above factors, the plantar fascia (the ligament that holds up your arch) is pulled or strained so that a portion of this very strong ligament starts to tear or fray like a rope at its weakest point (where it attaches to you heel bone). This tearing causes microscopic internal bleeding in this area. Your body reacts by causing inflammation, which in turn causes irritation to the nerves, bursae and muscles in this area. As the inflammation occurs, the body tries to heal itself by depositing calcium in the area of the tear. This creates the “spur”. Not everyone will have a visible spur on x-ray, especially in the early stages. The spur is not the cause of the pain! It is just a tangible sign that extensive tearing has occurred. The tearing and straining is the cause of the pain and then the nerve becomes inflamed which makes the pain more sharp and long-lasting. The straining must be stopped, along with the inflammation, in order to resolve this problem.
Diagnosis of plantar fasciitis is made with a physical examination including a biomechanical exam. X-ray are recommended to rule out a stress fracture or tumor in the area. Shoe gear is also evaluated. (Don't forget to bring your running shoes to your appointment!)
Treatment initially includes all of the items listed below. If any of these treatments increases your pain, please call or contact the office. It has been estimated that 85% of heel pain can be eliminated by non-surgical treatements; but these take time and effort on the part of the patient and doctor. BE PATIENT! Your heel pain did not appear overnight, and it will take a while to totally eliminate the pain.
Conservative therapy can include:
1. Ice (at least 15 minutes twice a day);
2. Stretching (your doctor will give you calf and arch stretching);
3. Anti-inflammatories (either orally or in an injection); and
4. Arch supports/Taping/or orthotics.
Remember that treating the biomechanics of your feet treats the underlying cause where the other treatments are only treating the symptoms! Some people need physical therapy, night splints, and casting for relief. Conservative treatment often takes 4-6 months to eliminate plantar fasciitis.
Surgical treatment is the last alternative, after conservative therapy has been exhausted. Extracorporal shock wave therapy (ESWT) is a relatively non-invasive surgery that is quite effective, but deemed experimental by many insurance companies. If you are interested in more information about ESWT, click on the word underlined above.
There are two common surgical approaches to heel pain: the traditional approach (removes the spur) and the endoscopic approach (lengthens the ligament to reduce the strain and therefore reduce your pain). If your pain is not eliminated by conservative treatment after 4-6 months, we will discuss which approach is best for you.
Remember, the earlier you seek medical help for heel pain, the faster it will go away! If you have pain more than 5-7 days in a row in the same spot, call or contact our office for an appointment.
Need help with stretching? Go to our video Donnie and Dr Crane amatuer video heping you stretch your way to pain relief on YouTube! You are not allowed to make fun of our amatuer photography!
Run Happy! And treat your heel pain early for the fastest results!
Free Book on Foot Pain! Why did we write it? Dr Crane explains!
...featuring Donnie! Better quality coming soon...this is our first attempt!
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