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Dr. Thomas F. Bembynista
Heel Pain—Heel Spurs and Plantar FasciitisOverviewPain in the heel is one of the most common types of foot pain. It can cause heel pain in the mornings and, after sitting for a period of time, with your first steps. It can be caused by stress on the feet by both daily activities and exercise. Causes of Heel PainWe use the terms plantar fasciitis and heel spur interchangeably for heel type pain. Side View of FootBack View of Foot Muscles
Click on the images to view a larger version There are many attached to the heel bone. The primary structures are the plantar fascia and plantar muscles. As we walk or run the arch flattens to absorb the bodies weight causing stress on the fascia and pulling away for the heel bone causing a bone spur. It normally takes years to develop spurs. Pain in the heel can be caused by the bone ,fascia or heel nerve. Poor fitting shoes and exacerbate the pain. The cost of the shoes are not as important as the fit. Make sure you have your feet measured once a year when buying new shoes. You should use well cushioned and supportive shoes with good lateral support. Signs and Symptoms of Plantar Fasciitis and Bone SpursThe pain can be centrally located in the heel or arch it can be worse in the morning and after sitting but improves as the day goes on. The pain with first steps in the morning and after rest is caused by pulling of the fascia and plantar muscles off the heel bone. If you have pain without weight bearing that is shooting in nature it is caused by the nerve pain on the side of the heel. Treatment for Plantar Fasciitis and Bone SpursHeel spurs are caused by inflammation at the insertion of the plantar fascia into the heel bone. The condition can be treated successfully using a conservative approach in 98% of the cases. Diagnosis includes a physical exam and possible a x-ray especially if a history of trauma. Heel pain and be reduced by using trigger point injections of a mild steroid from the side of the foot with a cold spray to numb the skin to significantly reduce the pain from the injection. Typically treatment requires 1 to 3 office visits for evaluation and injections. If nerve pain is present this causes shooting pain at rest this can be treated with dehydrated alcohol injections to destroy the painful section of the nerve. As we start treatment it's important to support the arch with a OTC arch support, wrapping the arch with reusable wraps or coban. When treating long term Custom Orthotics are choice they are constructed from a flexible plastic material and can made to fit both gym and dress shoes. If heel pain is intolerable or persists after conservative treatment, new treatments are available—PRP (platelet rich plasma) injections or Shockwave Therapy. Surgery today is rare but if necessary after all treatments is successful.
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Dr. Thomas F. Bembynista
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