What's Ailin' You? Plantar Fasciitis (Heel Pain)
Reproduced with permission from Oklahoma Magazine, March 2003

It sneaks up on you. At first, you think you've stepped on a stone and bruised your heel. The pain gets worse, and soon you're limping when you first get up in the morning. Finally, you see a doctor. You have plantar fasciitis, something you've never heard of and can't pronounce. You're about to learn that heel pain is a very big deal. "Plantar fasciitis is a by-product of being up on two feet and walking," explains Dr. Bryan Hawkins, a Tulsa orthopedic surgeon. "I've seen people who are absolutely at their wit's end with this condition."

What Causes PF?

Plantar fasciitis is an inflammation caused by stress on your plantar fascia - the band of fibrous tissue running along the bottom of your foot. The plantar fascia supports the arch of your foot, like a bowstring connecting the ball of the foot to the heel. When you walk - at the moment the heel of the back leg begins lifting off the ground - your plantar fascia endures tension that is about twice your body weight.

Untreated, plantar fasciitis will likely become chronic. It can be debilitating, particularly for people whose jobs keep them on their feet. PF can subside only to come roaring back with a vengeance. You may develop other problems because plantar fasciitis changes the way you walk. According to the American Academy of Orthopaedic Surgeons, you're more likely to get PF if you're a woman, if your calf muscles are inflexible, if you're overweight or if you suddenly increase your activity level. You're also vulnerable if you have very flat feet or unusually high arches.

How is PF Treated?

Finding an effective treatment is a challenge. What works for one person will be ineffective for another. Since PF is a repetitive stress injury, it makes sense that rest is the most effective treatment. However, keeping weight off your foot until the inflammation goes away is simpler than it sounds . . . few people are willing or able to lie down indefinitely just because their foot hurts.

"The average duration of the condition is about two years, but eight of every 10 people eventually get better with simple, inexpensive treatments," comments Dr. Hawkins.

Most people find relief with a combination of rest, ice, calf stretches and arch supports. Ice should be applied first thing in the morning, after activity and before bedtime. (Freeze water in a plastic water bottle and roll it back and forth under your arch and heel for 15 minutes.)

Foot taping might be required. (The web site www.heelspurs.com has diagrams of taping methods.) Losing weight has also proved successful for many. However, weight-bearing exercise makes PF worse.

Treatment for Chronic PF

Some people don't respond to conventional treatments. In these cases, surgery often proves successful. Dr. Hawkins explains that PF surgery "has a varying degree of aggressiveness." However, recovery time can be prolonged and patients may even require crutches. There is a new alternative to invasive surgery - orthotripsy.

"It works similar to the machine they use on kidney stones," explains Dr. Hawkins, who is part of the staff at Orthopedic Hospital of Oklahoma using the new technique. "Shock waves are aimed at the inflammation and this helps the tissue heal. There's no down time for the patient. When the FDA approved the technique for treatment of plantar fasciitis, the success rate was quoted as about 70 percent."

The Orthopedic Hospital has been doing orthotripsy since August, and Dr. Hawkins says he's extremely encouraged by how well the patients are doing.