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Conway McLean, DPM, Journal columnist

There are disabling illnesses, and then there are problems that we can and must live with. When someone suffers from chest pain or has trouble breathing, they understandably seek medical attention immediately. But many orthopedic ailments come on gradually and become more and more obvious over time. Although painful, many Americans will live with these problems for years. Yes, they may often need OTC painkillers or reducing their activity levels or that famous hot bath just to get by.

These chronic orthopedic conditions are familiar to most of us, either the result of a bike accident as a teenager or perhaps a sports injury in high school, even bad feet can lead to these non-disabling, chronic, painful issues…..that we can and must deal with Life. Is that a healthy approach? No, as this can lead to reduced activity levels and consequently reduced heart health. There is also the very important issue of quality of life.

One of the most common of these chronic orthopedic conditions is pain on the bottom of the heel. This can develop gradually and worsen over time, while others may notice the sudden development of a sharp, stabbing sensation from that area, often with exertion after a period of rest. Nearly one in ten Americans will experience ailments in this area at some point in their lives, with many describing the pain as disabling at some point.

Although there are many causes of heel pain, by far the most common is plantar fasciitis, which is inflammation of the arch ligament. This is a long band of fabric, similar to a band, that helps support the arch of the foot. There are numerous reasons for developing sustained excessive tension on this structure, the biggest being foot function: the biomechanics of walking and standing.

One of the most interesting features of plantar fasciitis is how many different treatments are used to treat the pain and change the course of the disease. The latter is relevant because it is often a recurring problem over the years. The treatment approach varies by healthcare provider. Some are more familiar with the pathology and all the different treatment options. Surgery is too often chosen prematurely, but studies show that it is rarely necessary. And complications from the most commonly performed procedure are common.

Many people treat their heel pain themselves, some successfully, many not. predictable, “DR Google” has much to say on the subject (often contradictory and imprecise). Thousands of products are sold that list heel pain as a good reason to buy their products. (When so many suffer from this condition, it only makes sense to list it as a treatment method.) Because the mechanical movements of a person’s foot and leg play a large part in the occurrence of heel pain, arch supports are a common method of treatment.

Unfortunately, many of the products sold are ineffective for most with plantar fasciitis. Of course, there are many causes of heel pain, but without question, the clear majority are due to this ubiquitous condition. That’s part of the problem: there are many factors at play in people who experience recurrent fasciitis. Their weight, the surfaces they walk on, their foot type, their footwear, their activities all play a crucial role. And this is just the beginning of a long list of factors to consider when evaluating and treating plantar fasciitis.

One of the most common problems is a tight Achilles tendon, the cord of which is attached to the back of the heel. This is the largest tendon in the human body through which the greatest forces pass. An overly tight Achilles tendon directly antagonizes the fascia and increases the likelihood of developing these conditions. Not surprisingly, a high percentage of Americans have an overly tight Achilles tendon.

Stretching exercises for this structure are common, but improvement comes only with prolonged effort. Many people fail at an ineffective stretching routine, either because of poor technique or an inconsistency. Others can take months to turn a profit. Nonetheless, a recent study showed that the benefits of a home stretching program are equivalent to those of a physical therapy program in which study participants went into the PT’s office. Stretching devices are commonly prescribed and some effective designs are available. Others do next to nothing and only serve to frustrate the user.

As mentioned, the most consistent treatment for those affected are insoles. But they must be appropriately designed and constructed to remedy the situation. Many people require a more customized, prescription-only device, a shoe insert, called a foot orthosis, or simply an “orthosis.” When a person’s gait is properly analyzed, their foot shape is accurately copied, and their function is adequately understood, insoles can safely and reliably correct plantar fasciitis.

Too often, injected steroids provide only temporary relief, and no other conservative therapies are attempted. The most common surgical procedure involves severing all or part of the arch ligament, and this can bring relief a good percentage of the time. But all too often there are complications (as with any surgical procedure), often involving a change in individual foot mechanics. Of course, this can have far-reaching consequences. Surgical technologies and techniques have advanced enormously over the last few decades. Many surgeries are performed because it is the only option. Using high-intensity radio waves to remove diseased tissue from the plantar fascia without severing this important structure has a high success rate. But with plantar fasciitis, conservative measures are almost always successful. Don’t jump into surgery; It’s not one “Miracle Weapon”, able to solve any condition without risk.

There are numerous approaches to treating plantar fasciitis, this common cause of heel pain. Sometimes it is helpful to pursue more than one method at a time, but there is always a way to relief. As the famous TV show once proclaimed, the truth is out there, the truth about your best path to heel pain relief. A thorough analysis generally provides the information needed to create a comprehensive treatment program. To achieve lasting benefits, you must discover your path to pain relief.

Editor’s Note: Dr. Conway McLean is a Physician practicing Foot and Ankle Medicine in the Upper Peninsula. The practice of dr. McLean, Superior Foot and Ankle Centers has offices in Marquette and Escanaba and now the Keweenaw, having recently added an office in L’Anse. McLean has lectured internationally and written dozens of articles on wound care, surgery and diabetic foot medicine. He is a specialist in surgery, wound care and biomechanics of the lower extremities.

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