Is Heel Pain An Epidemic?

We treat a lot of heel pain in our four offices, and it's obviously a diverse enough topic for us to dedicate an entire, weekly blog to it.
But is heel pain an epidemic? Diabetes is certainly an epidemic, but heel pain?
Past president of the American Podiatric Medical Association Michael King, who practices in Fall Rivers, Massachusetts, argues that it is, saying that he "sees 18 to 20 patients a day with plantar fasciitis. Heel pain is epidemic." As for a number of how many people who have this condition he can only guess. "Some people just tolerate the pain and try to get by."
Think about it: if you've had heel pain in the past, how have you dealt with it? Have you immediately made an appointment with a podiatrist, or have you said to yourself, "Well, I'll wait and see if this gets better. It's not that bad right now."? 
We've blogged a lot lately about athletes who have had multiple, recurrent cases of plantar fasciitis and heel pain. Joakim Noah has been in and out of basketball, Pau Gasol tried to ignore it and he ended up tearing his plantar fascia, and Albert Pujols has been suffering for seven years. Seven years!!! 
What frustrates podiatrists most about heel pain and plantar fasciitis is that it can be completely preventable when you take care of your feet and see a doctor right away. Who really wants to wake up in the morning and not be able to get out of bed because they can't move their feet? 
One of the culprits of heel pain is the flip-flop, the podiatrist's nemesis. "Flip-flops seem to be a major source of foot pain. People walk into the office wearing shoes that they should have replaced months ago," says podiatrist Elizabeth Kurtz, who practices in Chicago. 
King sees it too. "I see a lot of people with pain in the fall because they've been wearing cheap flip-flops all summer," he says. 
Heel pain doesn't just affect those who don't wear proper footwear. Runners and walkers are often hit with heel pain if they've recently increased their mileage or pace. It also appears in middle-aged people who live sedentary lives and have a little extra weight. 
If you've tried over the counter products, you'll find that they only provide temporary relief. Some will purchase heel cushions to try to ease the pain, but the source of the pain isn't actually from the heel- it's from the arch. Orthotics, whether over the counter or custom made by a podiatrist, will be the best fix for your heel pain, as they will ease the pain.
When looking to recover from heel pain, remember that it's going to take longer than a week. The damage that created the pain took longer than a week to develop, so it will likely take several weeks up to several months. Don't go barefoot and don't wear flimsy shoes, especially flip-flops. Our Bristol office offers shockwave therapy, which can reduce the inflammation and pain. Traditionally shockwave therapy has been used to break up kidney stones.
Reference: LA Times.
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
Visit our website, follow my tweets on Twitter, and like our page on Facebook.

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Botox Found To Help Plantar Fasciitis

A new Mexican study suggests that podiatrists should use Botox rather than steroids to relieve the pain their patients suffer from plantar fasciitis. The new research was published in the journal Foot and Ankle International.
Steroid treatment, for example cortisone shots, are often used in treating plantar fasciitis to reduce pain and swelling. It is estimated 2-6% of patients who receive steroid treatment as part of their conservative therapy will have their plantar fascia tear or rupture. Researchers from the Autonomous University of Nuevo Leon, Mexico came up with a clinical trial to compare steroid treatment with botox treatment, which works by blocking the neurotransmitter acetylcholine, weakening the muscles for several months.
In the trial, participants were treated with either steroids or Botox for their plantar fasciitis, and both groups were given the same series of stretching exercises to perform at home.
Initially, both groups were recovering at the same rate, but the Botox group took the lead with higher improved scores in foot pain, function, and alignment. Botox participants were the winners after six months, having better sustained and rapid improvement over their steroid counterparts.
The study's corresponding author, Dr. Carlos Acosta-Olivio says, "We found that a combination of BTX-A (Botox) applications into the gastroc-soleus complex and plantar fascia stretching exercises yielded better results for the treatment of plantar fasciitis than intralesional steroids." He added that the stretching exercises were an integral portion of successful treatment.
This was a small-scale study, with just 36 participants. The authors concluded by suggesting future trials include measures of body-mass index, as being overweight can be a risk factor for developing plantar fasciitis. When compared to steroid treatment, Botox treatment has fewer complications.
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
Visit our website, follow my tweets on Twitter, and friend or like our page on Facebook.

Acupuncture For Heel Pain

A new study concludes that acupuncture is beneficial in treating heel pain. Researchers note that acupuncture treatment is comparable to the use of medications, night splints, and stretching. Results show that acupuncture has more significant improvements in pain relief and restoration of function than a standard treatment plan, which includes anti-inflammatory medications.
Heel pain can be caused by a variety of conditions. Common causes are plantar fasciitis, fat pad atrophy, Achilles tendonitis, stress fractures, and baxter nerve compression. The baxter nerve is on the plantar side of the foot and may become entrapped, causing pain and numbness. Acupuncture is typically applied the relieve the inflammation of surrounding tissues to release pressure on the baxter nerve.
Plantar fasciitis is caused by the inflammation of the tissues around the plantar fascia, creating foot and heel pain. Patients often know when they have plantar fasciitis because they are unable to walk properly after getting out of bed first thing in the morning. Acupuncture helps enhance the micro-circulation of blood to the local region to nourish the tendons and ligaments. This allows for the healing process to decrease the inflammation surrounding the plantar fascia.
Fat atrophy of the heel pad is common in the elderly and those who have a history of steroid injections. Acupuncture helps reduce the inflammation, and therefore providing pain management for this condition.
Achilles tendonitis is a chronic condition to the major tendon that connects the heel to the muscles of the leg. When this tendon is inflamed, it makes walking very painful. Acupuncture can provide rapid relief for this condition and can also help heal the tendon and eliminate the heel pain.
Stress fractures of the calcaneous bone are typically caused by overuse and injuries. Acupuncture is used to relieve the pain by speeding the wound healing process of the fracture. Combined with rest and activity modification, acupuncture helps this type of heel pain.
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
Visit our website, follow my tweets on Twitter, and friend or like our page on Facebook.

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Does It Hurt? Cortisone Shot in the Heel

The answer to that question, is unfortunately, yes, for most people, getting a cortisone shot in the heel will hurt. However, the relief the shot provides outweighs any pain associated with the injection.
Cortisone is an anti-inflammatory medication, not a pain-killer. The injection is designed to disrupt the chemical process that leads to inflammation, the actual cause of the pain in heel pain. By reducing inflammation, pain often subsides. Cortisone injections are very safe to perform. Side effects tend to be very rare and minor. However, there are a few potential side effects of a cortisone injection that patients should know about.
Systemic side effects occur as a result of a small amount of the cortisone entering the bloodstream and affecting your entire body, not just the location where the cortisone was given. Unlike taking oral steroids, or having cortisone injected directly into the bloodstream, only a small amount of a local injection is absorbed by the body. And since the body actually produces cortisone naturally, most people do not experience systemic effects. Those who do may experience:
Elevated blood sugar
The most common systemic reaction is seen in diabetic patients. Patients with diabetes should carefully monitor their blood sugar as cortisone can cause a temporary rise in their levels. Patients taking insulin should be especially careful, checking their blood sugar often and adjusting the insulin doses, if necessary.
Facial flushing
Patients may experience flushing sensation and redness of their face. This reaction is more common in women and is seen into up to 15 percent of patients. This can begin within a few hours of the injection and may last for a few days.
Local side effects
Local side effects are those that are only experienced in one area of the body. The local side effects of a cortisone injection are also rare.
Pain
Some patients have discomfort after the injection and may experience an increase in pain 24 to 48 hours after being treated. This usually subsides quickly and can be aided with an ice pack and anti-inflammatory medication.
Infection
Whenever there is a break in the skin, like when a needle is used to administer cortisone, there is a chance of infection. Your doctor will sterilize the skin to minimize the risk of infection.
Skin pigment changes
Patients with darker skin should be aware that cortisone may cause skin around the injection site to change. This is not harmful.
Loss of fatty tissue
High doses of cortisone can have detrimental effects on some tissues in the body. When injected into fatty tissue, cortisone can lead to a problem called fat atrophy. Fat atrophy causes loss of fatty tissue, which can lead to dimpling of the skin or the thinning out of fat. Patients who get cortisone shots in the heel to treat plantar fasciitis may find walking painful as fat that cushions their steps may thin out.
Tendon rupture
Cortisone can also cause weakening of tendons. This is one reason your podiatrist will limit the number of cortisone injections administered. Cortisone can also lead to tendon rupture.
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
Visit our website, follow my tweets on Twitter, and friend or like our page on Facebook.

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Radiation Therapy May Help Heel Pain Sufferers

Those suffering from plantar fasciitis, or heel pain, experienced significantly less pain and improved quality of life following a treatment of external beam radiation therapy, a new study published in July in the International Journal of Radiation reports.
Between 8 to 10 percent of the population has severe heel spurs, and common treatments include icing, heat, and anti-inflammatory drugs. Most injections, like steroids and local anesthetics, only provide short-term relief for the patient.
The new study demonstrated that 80% of standard cases experienced complete pain relief with radiation therapy, with 64% having marked or constant pain relief during the 48 weeks following treatment.
Radiation therapy has been used for 60 years because of its anti-inflammatory effects, but the mechanism of action is unknown. Marcus Niewald, MD, PhD, a radiation oncologist at Saarland University Medical Center in Homburg/Saar, Germany came up with a randomized trial to compare the effect of standard dose radiation therapy with low dose radiation therapy among patients with plantar fasciitis.
There were 66 participants in the study and they were evaluated every six weeks until the 12 month clinical trial was over. Four patients were secondarily excluded once the trial began, 29 patients received the standard regimen, and 33 patients received the low dose regimen.
"After treatment of these 62 patients the difference between the effects of radiation therapy in the two arms became very clear in the clinical impressions, this urged us to perform an interim analysis, and finally, led to the decision to prematurely close the trial," wrote Niewald.
Five of the 29 patients in the standard dose group were retreated and had improved results. Researchers did not note acute side effects or long-term toxicity.
Limitations to the study included the facts that there was no placebo group, patients nor physicians were not blind to the dose group, and statistical power may be limited to the early closure of the trial. "Radiation therapy yields important pain relief in patients with painful heel spur (plantar fasciitis) compared with very low doses, and this could be proven at a high level of evidence for the first time," wrote Niewald.
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
Visit our website, follow my tweets on Twitter, and friend or like our page on Facebook.

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Does A Night Splint Help My Heel Pain?

If you wake up every morning and can barely get out of bed because your feet hurt so much, you probably have heel pain, or plantar fasciitis. Plantar fasciitis is the inflammation of the plantar fascia, the long band of ligament that runs from your toes to your heel.

There are many treatment options for heel pain, but one of the options that has the best success rate is the night splint. Night splints work by providing a constant stretch to the plantar fascia ligament overnight. While we sleep, our feet often go into a passive position, meaning they relax. When a ligament is relaxed for too long, stretching it, like after a night's sleep, causes the pain. This is a proven, effective method of treating heel pain. You will notice relief when you wake up in the morning and can walk with less pain! When wearing the night splint consistently you will notice a progressive relief of your heel pain.
The type of night splint we prescribe for our patients is the Active Innovations Dorsal Night Splint. It is designed to hold the foot in a neutral position during sleep, thereby helping to alleviate the morning pain and discomfort associated with plantar fasciitis. The overall benefits of this night splint are: low profile, less/bulk/weight, less heat retention, increased comfort during sleep, increased usage by patient, and easy night-time mobility.
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
Visit our website, follow my tweets on Twitter, and friend or like our page on Facebook.

What Are Orthotics?

Orthotics, also known as orthoses, refer to any device inserted into a shoe, ranging from felt pads to custom made shoe inserts that correct an abnormal or irregular walking pattern or pain, like heel pain. Sometimes called arch supports, orthotics allow people to stand, walk, and run more efficiently and comfortably. While over the counter orthotics are available and may help people with mild symptoms, they normally cannot correct the wide range of symptoms that prescription foot orthoses can since they are not custom made to fit an individual's unique foot structure.
Orthotic devices come in many shapes, sizes, and materials and fall into three main categories: those designed to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.
Rigid Orthotics

Rigid orthotic devices are designed to control function and are used to primarily for walking or dress shoes. They are often composed of a firm material, such as plaster or carbon fiber. Rigid orthotics are made from a mold after a podiatrist takes a plaster cast or other kind of image of the foot. Rigid orthotics control motion in the two major foot joints that lie directly below the ankle joint and may eliminate strains, aches, and pains in the legs, thighs, and lower back.
Soft Orthotics
Soft orthotics are generally used to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. They are usually effective for diabetic, arthritic, and deformed feet. Soft orthotics are typically made of soft, cushioned materials so that they can be worn against the sole of the foot, extending from the heel past the ball of the foot, including the toes. Like rigid orthotics, soft orthotics are made from a mold after a podiatrist takes a plaster cast or other kind of image of the foot.
Semi-Rigid Orthotics
Semi-rigid orthotics provide foot balance for walking or participating in sports. The typical semi-rigid orthotic is made up of layers of soft material, reinforced with more rigid materials. Semi-rigid orthotics are often prescribed for children to treat flatfoot and in-toeing or out-toeing disorders. These orthotics are also used to help athletes mitigate pain while they train and compete.
Orthotics are most often prescribed for patients with heel pain to alleviate the strain on the plantar fascia. It is one of the many ways we treat heel pain in our office.
Jeffrey S. Kahn, DPM
Connecticut Foot Care Centers
Heel Pain Doctor in CT
Podiatrist in Rocky Hill and Middletown, CT
Visit our website, friend and like our page on Facebook, and follow our tweets on Twitter. 

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