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
Visit our website, follow my tweets on Twitter, and friend or like our page on Facebook.
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Thursday, November 1, 2012

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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Thursday, October 25, 2012

Home Treatments For Heel Pain

When you have heel pain, there are some things you can be doing at home to help alleviate the pain.
1. Rest. When you experience intense pain, stay off your feet and put them up for several hours a day to relieve the strain on the plantar fascia. When you are able to return to your normal routine, avoid overexercising. Reduce the distances you walk or run, or switch to a low-impact activity such as swimming or cycling to avoid strain.
2. Ice. Apply an ice pack to the painful area three or four times a day for up to 20 minutes to reduce pain and inflammation. You can also place a tennis ball in the freeze and roll or massage your foot over the tennis ball.
3. Arch supports. Over-the-counter or office dispensed orthotics may be a quick fix for mild cases of heel pain, or when you're waiting for your custom orthotics to be made. Orthotics relieve the tension on the plantar fascia, Achilles tendon and calf muscles by redistributing your weight.
4. Stretches. Browse through our blog for many exercises and stretches you can do at home to help your plantar fasciitis.
5. Over-the-counter medications. Ibuprofen may reduce the pain and inflammation of heel pain.
6. Wear supportive shoes. That may mean you will have to go through your closet and get rid of all shoes that are old, worn, non-supportive, too-tight, too-loose, and ill-fitting. This is often the reason why heel pain comes back for many people- they do a quick fix on the heel pain, but do nothing to prevent it from coming back in the future. One way is to go through your shoes. All shoes should have good arch support, a low to moderate heel, and have heel support. If your shoes don't have these qualities, toss them! You'll thank us, we promise.
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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Thursday, October 18, 2012

Platelet-Rich Plasma Therapy and Heel Pain

If you're struggling with heel pain, you know how difficult it is to even get out of bed in the morning. Perhaps you've been to a podiatrist and tried all of their recommendations, including a cortisone shot, but have had no luck in feeling any pain relief. 
New to the field of podiatry is platelet-rich plasma therapy, which has been effective in treating extreme plantar fasciitis. If you've had no success with conservative treatment options, this may help you.
Platelet-rich plasma takes a different approach to healing than a traditional cortisone shot does. Instead of having cortisone injected into the affected area, a combination of plasma and platelet fluid are shot. Both of these substances help connective tissue grow and promote vascular healing, as well as aid with inflammation.
Platelet-rich plasma therapy's natural healing process intensifies the body's efforts by delivering a higher concentration of platelets. To create PRP therapy, a small sample of your blood is taken and placed in a centrifuge that spins the blood at high speeds, separating the platelets from other components. The concentrated PRP is then injected to and around the affected injured area, jump starting your body's natural healing signal. Because your own blood is used, there is no risk of transmissible infection and very low risk of allergic reaction.
The procedure takes any where from one to two hours, including preparation and recovery time. Most people return to their jobs immediately after the therapy. Up to three injections may be given within a six month time frame, usually three weeks apart.
Studies show that patients who received this treatment showed improvement after four weeks, which was consistent for a year after receiving the shot. MRI and ultrasound images show considerable definitive tissue repair after the treatment. The need for surgery is greatly eliminated with this therapy.
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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Thursday, October 11, 2012

Heel Pain Stretch of the Week: Piriformis Stretch

Lie flat on your back with knees bent. Cross the right knee over the left thigh. Stabilize the left thigh with your arms. Gently pull the right knee toward your chest until a comfortable stretch is felt in the buttock/hip area. Reverse legs and repeat.
Hold 30 seconds. Repeat 5 times for each leg, 1 time per day.
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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Thursday, October 4, 2012

Heel Pain Stretch of the Week: IT Band Stretch

Stand with your left side 2-3 feet from a wall. Place your left hand on the wall and cross your right leg across your left leg. Lean into the wall until you feel a gentle stretch in your left leg. Turn around and reverse arms and legs to stretch right leg.
Hold 30 seconds. Repeat 5 times for each leg, 1 time per day.
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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Saturday, September 29, 2012

Nene Still Struggling With Plantar Fasciitis

UPDATE
As we blogged a few months back, Washington Wizards center Nene was suffering from plantar fasciitis. Now, several months later, and after recuperation time, we had hoped he would feel better.
Nene's status for the start of training camp next Tuesday is still up in the air, said team president Ernie Grunfield in a press conference at the Verizon Center. Nene, playing for Brazil's Olympic basketball team, struggled with plantar fasciitis throughout the Games.
"He hasn't had time to rest this summer because of the commitment he had to his national team. So we're going to be very, very cautious. We're going to take it very slow with him and make sure he's 100 percent when we put him out there full time," said Grunfield.
During the regular season Nene missed 10 consecutive games for the Wizards with heel pain, but returned to play the final five games. Last season he averaged 14.5 points and 7.5 rebounds in 25.8 minutes, shooting 60.7 percent.
Fans in Denver and Washington have grown frustrated by Nene's health issues, but there is no comparing his plantar fasciitis to the cancerous testicular tumor the 6 foot 11 inch native of Sao Carlos overcame in the 2007-08 season.
"We expect him to be ready for the regular season, for sure. But we will be very cautious with him," said Grunfield.
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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