Heel pain is one of the more common concerns that bring patients to the offices of foot specialists or podiatrists. It happens to professional athletes, joggers, people who work on their feet and many people who exercise to stay in shape or lose weight.
Heel pain is most often caused by plantar fasciitis, a condition that involves pain beneath the heel and sometimes the arch. The plantar fascia is the ligament that runs from the heel bone to the ball of the foot, and is responsible for support of the foot.
Patients often feel heel pain upon arising in the morning or after long hours of standing. Heel pain may also be due to other causes such as a stress fracture of the heel bone, entrapment of one of the small nerves on the bottom of the heel, tendonitis, arthritis, nerve irritation or rarely, a cyst.
A list of the more common causes of heel pain is available at www.heelpain.pro.
Plantar fasciitis can be a simple strain of the fascia, the thick band of tissue that goes from the base of the heel to the ball of the foot. Acute plantar fasciitis is an overuse injury that is often self-limiting and treatable with rest, ice, massage and anti-inflammatory medications.
Dr. Ed Davis often sees patients who have had heel pain for months, occasionally years, but have not received the aforementioned treatment.
The “gold standard” to examine the fascia is diagnostic ultrasound. Ultrasound can help establish not only the diagnosis of plantar fasciitis, but also if the condition is acute, chronic or even degenerative.
Longstanding heel pain often involves degeneration of the fascia, more accurately termed plantar fasciosis. Plantar fasciosis, previously called “intractable plantar fasciitis,” was treated surgically by cutting the fascia. Such treatment involved a long recovery period and uncertain results.
New and more successful technologies are either noninvasive or minimally invasive. ESWT, or extracorporeal shockwave therapy, is noninvasive, as are laser treatments. PRP, or platelet rich plasma, is also minimally invasive, and so is the Topaz procedure. Visit www.topazprocedure.com for more details.
ESWT was discovered in Germany in the late 1980s. It involves the application of pressure waves or sonic shockwaves to diseased tissue, which induces the body to replace the diseased tissue with healthy tissue. It has better than an 85 percent success rate for plantar fasciosis, but is ineffective for plantar fasciitis.
Again, it is imperative that the diagnosis of plantar fasciosis vs. fasciitis be established by diagnostic ultrasound. The success rate for Achilles tendinitis is higher yet, in the low 90s.
ESWT, when first introduced to the United States about 12 years ago, was performed primarily with “high energy” machines requiring anesthesia in an operating room. The third generation of ESWT machines available in the United States – such as the Swiss DolorClast, which Davis utilizes in San Antonio – are utilized in the office and generally do not require anesthesia. The cost of ESWT in the United States is currently about 25 percent of that of a decade ago, making it accessible to most patients.
The Topaz procedure is a minimally invasive procedure performed through very small, pinhole-size incisions on the bottom of the heel. The instrument utilized is a small wand through which a radiofrequency is applied to create a plasma field at the tip. The diseased tissue of fasciosis can be significantly reduced with this instrument.
Relatively rapid return to work often occurs, as the procedure is minimally traumatic.
PRP has become popular in professional sports to get players back in the game. Platelets are blood cells that are involved in the clotting process and contain growth factors that enhance the healing process. PRP is derived from the patient’s own blood, so adverse reactions to this product are very rare. PRP can be used as a standalone treatment or as an adjunct to other forms of treatment in order to speed the healing process.
Davis often combines the Topaz procedure with PRP.
Dr. Ed Davis is a podiatrist in San Antonio, Texas, with more than 25 years of experience. He is a graduate of Temple University School of Podiatric Medicine, and he is board certified in foot surgery by the American Board of Podiatric Surgery. You may contact him at 210-490-3668 or www.southtexaspodiatrist.com.
