Heel Pain Wellness Center Of America
Heel Pain & Plantar Fasciitis Treatment
At Mid-Ohio Foot & Ankle Specialists we are revolutionizing the treatment of heel pain with state-of-the-art technology in as little as 1 session. No time off from work and minimal decrease in activities.
Most surgeons are trained to perform an EPF which releases a portion or all of the plantar fascia, which is your foots shock absorber. With our high intensity focused shock wave treatment one session is successful in decreasing the severity of your heel pain almost immediately with a 92% success rate in treating the symptoms. There is no need to go to the hospital or a surgery center to have this procedure performed.
Germany who leads the medical world in the newest procedures, techniques and instruments has been a proponent of the high intensity shock wave treatment for over 30 years. They are against releasing the plantar fascia as it changes the structure and function of the foot over time.
The physicians certified by Mid-Ohio Foot & Ankle Specialists in ESWT are truly state-of-the-art practitioners, and are dedicated to reducing the need for invasive surgery.
At Mid-Ohio Foot & Ankle Specialists we use an FDA approved high intensity shock wave treatment machine called the Medispec. With one treatment of focused pressure waves the tissue becomes flexible again and the blood flow will return to the area healing the damaged plantar fascia thereby eliminating your pain over a few days to a few weeks.
This procedure is done in the office under a local anesthesia to numb the foot in one 30 minute session. You go home in your shoes and limit your activity for 3 days. Some patients require an additional shock wave depending on the severity and the longevity of the plantar fascial damage. As it took time to create the injury, the healing process also takes time.
This can be repeated usually after 4 months if there is less than a 60% decrease in the heel pain symptoms from the 1st procedure, usually in about 10% of the patients at which time there is a 98% success rate after the 2nd treatment. When reviewing the studies, total resolution of the heel pain may take up to a year but a huge decrease in the pain is noticed immediately after the procedure. Unlike invasive surgical procedures, with ESWT you are walking the same day and back to work and activities in a few days instead of a few months.
COMPARISON BETWEEN ESWT AND EPFESWT PROCEDURE & POST-OP COURSE AT Mid-Ohio Foot & Ankle Specialists (CHRONIC > 6 MONTHS PLANTAR FASCIITIS)
Local anesthesia to the heel – you will be awake – performed in the office
High intensity shock waves performed in-office to the plantar fascial insertion site which breaks down the calcifications in the tissue and causes an increase in the blood supply thereby beginning the healing process.
- No post – procedure pain medications required – tylenol is sufficient
- You are back in your shoes the same day
- 3 days of minimal activity then resume work
- Activities can also begin after the 1st 3 days
- No rigid inserts (orthotics) for you shoes required
EPF PROCEDURE & POST-OP COURSE BY OTHER SURGEONS
Sedative anesthesia in hospital or surgery center – you will be asleep
- Endoscopic release of the plantar fascia which is your foots shock absorber
- Post-operative pain meds will be required
- 6 – 8 weeks off work in a surgical boot or surgical shoe
- 6-12 month recovery course
- Afterwards you will be dependent on a hard rigid arch support to prevent the collapse of the arch over time
- Can lead to a flattening of the arch which will make one leg shorter than the other causing lower back, hip and knee pain over time
REMEMBER: You can live a pain free life. Even if all previous treatments have not been successful there is no need for surgery with our proven techniques. Our treatment protocols have had successful results in resolving heel pain for the last 20 years. Let us help you get back to enjoying your activities pain-free!
CAUSES
The plantar fascial band of tissue through long-term micro-trauma leads to the tissue pulling away from the heel and causing a gap which the body begins to lay down bone and a heel spur forms. Heel spurs do not hurt, they are not at the level of a joint where they are being impacted upon. More importantly when the tissue pulls away from the heel it is tearing the blood vessels that are feeding the tissue and the process of calcification (drying of the tissue) begins causing the tissue to harden and lose its flexibility. In other words the plantar fascia which is your foots shock absorber is beginning to rust. When that rust pocket gets big enough it places pressure on the infracalcaneal nerve which passes beneath the heel and causes pain. With high intensity shock wave therapy the calcifications are broken apart increasing the flexibility of the tissue and these shock waves also lead to an increase in the blood flow to the area thereby healing the tissue.
DIAGNOSIS
Diagnosis is made by palpating the bottom and the inside aspect of the heel and eliciting pain along the nerve. X-rays are taken to check the alignment of the foot and the size of the heel spur if present. Next diagnostic ultrasound is used to measure the thickness of the plantar fascial band of tissue and the color. The normal plantar fascial band of tissue is less than 4mm in thickness and has a light color indicating good blood flow. Damaged tissue is thicker and darker indicating traumatic disruption of the foots shock absorber.
TREATMENT
Conservative treatment is effective in resolving heel pain in 80% of the population. This consists of steroid injections, cushioned insoles, arch supports, padding, stretching, pain creams and radial epat therapy consisting of multiple treatments weekly x many weeks which can be helpful in resolving acute or short term plantar fasciitis (<6 months)
When considering your options for treating heel pain after conservative therapy has been tried to no avail think about this. You wouldn’t go out to your car and remove a shock absorber and drive around with only 3 would you? Then why would you do that to your foot? The EPF procedure releases your plantar fascia, which is your foots shock absorber. You are changing the structure and function of the foot and muscles which will lead to other conditions over time such as knee, hip and back pain. High intensity shock wave therapy is the safest and most effective treatment for the resolution of heel pain. Another analogy would be a bridge that has 4 connecting points and 1 of those points will be released. Would you still drive your car over that bridge? That’s EPF.
The physicians at mofas have been performing eswt procedures since 1999 using both the medispec and the dornier successfully instead of invasive procedures thereby returning patients to normal activities within days instead of months.
Most surgeons, myself included, are trained to perform the EPF release and some may not even know about the benefits of utilizing ESWT. Also, ESWT technology is costly and this investment is simply not feasible for most medical offices.
Once in the treatment room, you will lie back on a comfortable table with your foot resting on a water-filled membrane. The area of pain is then detected and marked using palpation and ultrasound. To ensure your comfort, local anesthesia is used to numb the foot so that no pain during the treatment is felt.
Some patients may experience post-treatment discomfort when the local anesthetic wears off usually from the injections to numb the foot. This can be lessened with the use of tylenol. We do not recommend ice or heat or anti-inflammatories as the healing process has begun immediately and we do not want to hinder the progress. You are back in your shoes immediately after the procedure and able to return to work and activities, preferably in 3 days, to allow the initial inflammatory process to subside.
In regards to foot and ankle conditions, ESWT can treat a wide range of musculo-skeletal conditions with one (1) treatment. Most common areas of treatment include points of muscle and ligament attachments. These include plantar fasciitis, achilles tendonitis, posterior tibial tendonitis and peroneal tendonitis. Treatment can also be used on non-union fractures, stress fractures, avascular necrosis, sesamoiditis and chronic ulcerations.
Having performed ESWT procedures for over 20 years, our experience correlates with the FDA study using our treatment protocols. In the study the average pain level was 7.7 before treatment. After receiving one (1) ESWT treatment, the patients at one year follow-up rated their post-ESWT pain at 0.6. Our studies show a 92% decrease in pain which is much higher than any non-surgical or surgical procedure. Most importantly, ESWT is very safe.
If you have experienced your condition for more than 6 months or have tried at least 3-4 other conservative therapies without success then you may be a candidate for the ESWT procedure. Conservative treatment options consist of stretching, inserts, taping, anti-inflammatory medications, physical therapy, injections, laser or EPAT therapy and shoe wear changes. Waiting too much longer will only lead to other problems from altering the way you are walking because of the foot pain. This can lead to foot, ankle, knee, hip and lower back pain over time.
Achilles Tendonitis
CAUSES
The Achilles tendon is one of the only muscles to cross three (3) joints in the human body including the knee, ankle and subtalar joints. The Achilles is one of the strongest muscles in the lower extremity and helps with lifting the heel off the ground when walking and jumping thereby propelling the foot downwards and forwards. This constant pull of the muscle may lead to an overuse syndrome causing strains, sprains and tears in the tissue which lead to pain and swelling in the area. The palpable cord area in the back of the heel is known as the watershed area and can become inflamed with a nodule forming from micro tearing of the tissue. There is also Achilles tendon pain at the level of the insertion point on the back of the heel bone called the calcaneus which may or may not have a large bump associated with it known as a Haglund’s deformity. Most commonly seen in runners, weight lifters or even children whose growth plates are not closed yet (severs disease), this condition can also occur due to inactivity with sudden bursts of exertion in sedentary people.
DIAGNOSIS
Patients who suffer from Achilles tendon pain most commonly relate an instance when they first felt the pain from running, exercise, shoe gear or just getting up one day and feeling a sharp pain in the back of the heel. Runners will slow there activity due to the pain and most people will state they hurt whenever trying to get up and walk. Diagnosis is made by palpating the Achilles tendon cord and insertion site and eliciting pain. X-rays will be used to determine if there is any spurring or calcification of the Achilles tendon. Diagnostic ultrasound is also used to measure the thickness and color of the tendon and to determine if there is any tearing in the tissues. An MRI may also be recommended to check for the level and degree of damage to the tissue.
TREATMENT
Most commonly conservative treatment for Achilles tendon pain begins with stretching exercises, heel lifts, arch supports, icing, anti-inflammatory creams and steroid injections to break the pain cycle and decrease the inflammation so the patient is able to stretch comfortably to help increase the range of motion of the muscle. If any or all conservative measures do not resolve the heel pain we at Mid-Ohio Foot & Ankle Specialists do not recommend an open procedure for Achilles tendonitis resolution. We highly recommend extracorporeal shock wave therapy (ESWT) as described in the heel pain section to help break up the calcifications and initiate blood flow which will decrease the pain and swelling and get the patient back to their normal routines sooner. With the open surgery procedure you are non weight bearing for 4-6 weeks and off work for 3-4 months. With the high intensity shock wave therapy (ESWT) procedure we recommend 3 days off work to allow the inflammatory process to take effect and then slowly increase your level of activity over a period of a month. You are in your shoes the same day full weight bearing and walking with little to no pain.
Heel Pain Questions and Answers
What is the most common cause of heel pain?
The most common cause of heel pain by far is plantar fasciitis. The plantar fascia is your foot's shock absorber stretching from the heel to the toes. When this becomes damaged, it thickens and hardens losing its elasticity. In other words, your foot's shock absorber is rusting.
What does pain in the heel indicate?
Pain in the heel means there is inflammation of the plantar fascial band of tissue, the foot's shock absorber on the bottom of the foot or pain in the back of the heel associated with Achilles tendonitis. It can also be caused by stress fractures of the heel bone or on occasion, bone cysts.
What causes heel pain that comes and goes?
Most commonly repetitive activities can exacerbate heel pain such as high-impact activities, such as running or sports. Most people will say they have the pain not during the activity but sometimes soon afterward. This is because the damaged tissue is inflamed and putting pressure on the surrounding nerves causing the nerve to inflame which leads to pain.
When is heel pain serious?
Heel pain is serious when you have trouble walking, standing on your toes, bending your foot downwards, or have severe pain and swelling around the heel. Seeking medical advice to evaluate this condition should you deem it severe is highly recommended to rule out any more severe causes.
Does heel pain ever go away?
If the heel pain is associated with a certain activity such as after using the treadmill or playing sports, this will usually ease up with a decrease in the activity that aggravates the heel pain. One can also try rest, icing, massaging the heel, pain creams, and anti-inflammatories to help with the pain.
What is the best treatment for heel pain?
The best home treatments for heel pain are rest, icing, stretching, rolling your foot on an ice water bottle, anti-inflammatories, and CBD creams. Also trying over-the-counter arch supports and a more supportive shoe throughout the day will help to decrease the amount of arch flexion and lessen the inflammation.
Does walking on tiptoes help plantar fasciitis?
The short answer is no. walking on tiptoes, walking up stairs, and walking barefoot can all aggravate the plantar fasciitis causing increased heel pain.
Does plantar fasciitis go away naturally?
Plantar fasciitis can go away on its own if you take the necessary steps to curb the aggravating factors. Stop the activities that are causing the discomfort, wear better supportive shoes, avoid going barefoot, constantly stretch daily, and wear arch supports are a few ways to help the plantar fasciitis subside.
Is there surgery for heel pain?
The most common surgery in the USA for the treatment of plantar fasciitis is endoscopic plantar fasciotomy (EPF). This surgery releases a portion of the plantar fascial band of tissue thereby decompressing the nerve and easing the severity of the plantar fasciitis. This requires 6-8 weeks off work for the healing process.
What is the best treatment for heel pain?
By far, the best treatment for heel pain is called high-intensity extracorporeal shock wave therapy (ESWT) not to be mistaken for radial ESWT which is a form of physical therapy and requires multiple sessions over a couple of months time. High-intensity ESWT breaks up the calcification in the heel, thereby increasing the flexibility of the plantar fascial band of tissue with 1 treatment. No surgery is required, no medications, and back to work and activities in a few days.
Is heel pain serious?
Heel pain can be serious if there is redness, swelling, increased heat to the area or you are running a fever the longer you let the condition go, the more damage you do to the tissues and this can lead to a longer recovery time. Always see a healthcare professional if you feel your condition is serious.
