Articles By Dr. Zawada
My Heel Hurts! By Stanley Zawada DPM
Heel pain can be a severely disabling problem causing one to limp and generally ache all over as the body attempts to shift pressure off the painful foot. As the “good” is now strained past its normal demand for support, it too can begin to hurt.
Classic symptoms are pain in the heel taking the first step out of bed in the morning, or after sitting for awhile and then standing, or, it can be constant and nagging occurring with walking or any combination of the above.
The cause of heel pain in this classic scenario is due to microscopic tearing of a thick, strong ligament -the plantar fascia- that attaches to the heel of the foot causing a medical condition known as “plantar fasciitis” or heel pain.
The heel and arch area’s of the foot will show swelling, pain, and increased temperature.
The sooner one gets help, the better. The longer one waits, the longer it may take for the various treatments your podiatrist has available to treat you to work.
The first thing your podiatrist will do is a history and physical exam and then may order x-rays to check for the presence of anything not visible to the naked eye. It is important to be completely honest and thorough with your doctor about your entire medical history leaving nothing out.
Reasons for taking an x-ray include:
*Looking for a possible fracture in the bone that might account for the pain?
*Looking for a foreign body (such as a pin, needle, lead-based glass fragment, other) that shows up on the x-ray that may be the cause of the pain.
*Looking for a bone spur on the bottom of the heel bone, but usually, the presence of this “heel spur” is usually not the cause of the pain. It is a sign of longstanding stretching of the ligament mentioned above, but the spur itself is usually not the cause of the pain. It can be, but only if it gets large enough to cause enough pressure on the surrounding structures to cause pain.
Other causes of heel pain include, but are not limited to: injury, infection, systemic disease (such as rheumatoid arthritis), old injury “flaring up”, weight gain and more. Your podiatrist is trained to determine the actual cause and order an appropriate treatment.
In the classic situation, your podiatrist can prescribe a course of injections of a cortisone-like compound to reduce the pain and swelling plus a taping of the foot to relieve the stretched and damaged ligament, or plantar fascia, as noted above.
Understand that cortisone is something each and everyone of us make in our bodies each and everyday.
Cortisone is essential to life.
Cortisone is made by our adrenal glands, which sit on top of our kidneys.
Cortisone is a hormone made by the body in response to various forms of stress. It raises the blood sugar, stabilizes cellular structures and in general, causes a temporary increased ability to handle whatever stress we are being subjected to at that time.
When you don’t make enough cortisone, you have a condition known as “Addison’s Disease”.
John F. Kennedy had Addison’s Disease. His body did not make enough cortisone. He was on death’s bed several times in his life and was given the last rights more than once. He was a frail, weak child and teenager. When cortisone first became available in the late 1940’s, his father, Joseph, had cortisone held in various locations all over the world so that his son (“Jack”) would always have it available when he needed it.
So cortisone isn’t all as bad as its reputation seems to give it.
In the treatment of certain disease conditions (rheumatoid arthritis, multiple sclerosis and others) the person has to take daily doses of cortisone (or prednisone or similar compounds) that over long periods of time (many months and years) can lead to water retention, body swelling, “moon face” and other consequences of taking cortisone-like drugs for these very, very long periods of time.
But the injection of a small amount of cortisone into the heel has never been shown to be associated with these kinds of side-effects and no patient should ever be concerned when their doctor or podiatrist recommends a “cortisone shot”, as long as there is no history of allergy to it or another unfavorable reaction.
In addition to, or instead of, cortisone some doctors may prescribe some anti-inflammatory pills to either supplement the injection, or in milder cases to use alone without injections.
What we, as medical professionals, do in large part is to create the conditions for your body to heal. We do not actually reach into your body and “heal” you. Instead we create the conditions for your body to do what it does naturally.
Depending on your response to the initial treatment, much more (or less) can be done beyond what is done on your first visit to give additional help to your body to heal. Trust your podiatrist or medical professional to know best what to do.
“How long will it take for me to get better?”
This is a common question, and the answer is highly variable because everyone is different.
It is impossible to predict how any single person will respond and how long it will take for them to get better.
Some patients are so-called “one-shot wonders” meaning they get one injection and they’re 100% better. These are rare.
Most patients require several visits with injections, oral medication, tapings, stretching exercises, night splints, custom-made arch supports (“orthotics”) and more, in various combinations, to achieve long term pain relief.
Some patients who do not respond satisfactorily may become eligible for shockwave therapy if, after 6 months of conservative treatment, they are not better.
Some patients, those who do not respond to the above conservative treatments, may need surgery.
This is a brief discussion by Dr. Stanley Zawada of heel pain, its causes, and how it can be treated.
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