Thursday, November 8, 2012

Cutting Calf Muscle To Cure Heel Pain: Too Extreme?

Liam Horner was an average 22 year old who liked to play football (soccer in the US). But a nagging pain in his heel developed into a serious and debilitating condition that caused him to give up his game.
"I also had to give up my job in the building trade because I was on my feet all day," said Horner. "Even to get out of the house I had to bathe my left foot in hot water to loosen up the muscles.
Heel pain affects one in every ten people in their lifetime, 75% of which are women. For most, stretching and wearing orthotics relieve the pain. Others will find relief in shockwave therapy or cortisone injections. But many still suffer in pain.
Horner's doctor prescribed orthotics and sent him to physical therapy, but those options give him little relief. He tried acupuncture as well, but that had little effect. Turns out the root cause of Horner's pain was not in his heel, but in his calf muscle.
"Some people have particularly tight muscles which means the heel is pulled upwards in the same position as when you point your toes," explains Matthew Solan, consultant orthopaedic surgeon at the London Foot and Ankle Center. "The plantar fascia which is the tendon in the heel is never able to relax and becomes highly inflamed."
The solution for Horner was a gastrocnemius release, which involves carefully cutting the calf muscle during surgery to create greater flexibility. "If you imagine the lower leg as a rasher of bacon, the calf muscle is the bacon meat but like the rasher it is covered by a rind. You can only stretch the bacon itself so far because the rind remain tight and limits flexibility. If we carefully cut the rind then the rasher can be stretched further," says Dr. Solan, who learned the technique in France and now performs more of these procedures in the United Kingdom than any other physician.
"This small operation is a way of stretching the tight calf muscle in a very controlled way to allow the release of the strain from the affected heel area." This procedure is typically carried out as a day case with the surgeon making a small incision behind the knee to access the calf muscle.
"I had my surgery at around 8am and by lunchtime I was able to walk up and down the hospital stairs so was discharged by the afternoon," said Horner. "The recovery was very quick indeed. There was very little pain, no more than the occasional tweak if I over-stretched during the first week. I was able to go for a short run within two and a half weeks of surgery. I noticed a difference in my heel pain almost straightaway. By six weeks I was playing football again and within two months I was fully recovered. Most people with heel pain find other treatments help them but if like me you are left with long term, intractable pain it has a very significant impact on your life. I had to change my job and give up sport."
"It was only when I was seen in a specialist center that my problem was properly assessed and effectively addressed. I do hope this treatment will become available to more people," said Horner.
If you are experiencing heel pain, call our Rocky Hill or Middletown office to make an appointment.
Jeffrey S. Kahn, DPM
Connecticut Foot Care Centers
Heel Pain Doctor in CT
Podiatrist in Rocky Hill and Middletown, CT
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