HEEL PAIN / PLANTAR FASCIITIS
Plantar fasciitis [fash-y-itis], often pronounced face-y-itis], is one of those medical enigmas [mysteries]. It is one of the most intriguing to me of all of the foot maladies I encountered.
I consider myself an expert on PF since I've been a health care provider and educator for over 40 years, and I've treated and helped thousands of patients during those years.
Once upon a time, lots of fat ladies who came to me with pain in their heel / heels. They were usually around 45 to 65 years old. They mostly wore flip-flops or backless shoes / scuffs. They had severe pain when arising, that subsided after 15 - 20 minutes of ambulation. There was an occasional man who fit the same model. X-rays usually showed a heel spur, but not always, [this is significant for this problem - plus many other pain issues].
Other male and female overweight patients came in with the same story, however the X-rays did not -show a heel spur.
Then, as years went by, lots of young ladies, and young men, slim and trim came in to see me with the same symptoms. Some had spurs on their X-ray's, others didn't?
Now, at this point, as a behavioral analyst - podiatrist, I'm beginning to wonder? What's the deal? A cortisone shot helped one, but not the other? Orthotics helped one, but not the other? Surgical removal of the spur on one was a miracle, but made the next one worse? I even employed the use of an ultrasound imagery device which showed exactly where I was placing the needle, and the cortisone injection. This helped a little, but not a miracle. Physical Therapy never worked. Acupuncture & Chiropractic was a crap-shoot too.
Heel pain may be a result of the following:
Inflammation of the fascia
Inflammation of the periosteum
Strain of Flexor Brevis and or Quadratus Plantae muscles
Subluxation of the Calcaneal - Cuboid joint
Shortening of the Gastrocnemius Muscle (Calf Muscle)
Compression of the Sciatic Nerve
Note. I didn't mention heel spur. I saw countless patients who had heel spurs that never had a twinge of pain. I saw countless patients who had pain but no spur. I removed countless spurs and the patients often still had pain after healing was complete.
So, x-rays, ultrasound, MRI, nuclear bone scans can all be helpful in the diagnosis and treatment of heel pain. Obviously, if one has a sciatic nerve problem a steroid injection in the plantar fascia is not going to help.
After I learned how to perform Bowen's Medical Bodywork Technique in 1995, a little more light was shed on the subject. Tight lower leg muscles which were released, offered another solution. Release of the Gluteal muscles over the sciatic nerve offered some others a solution.
So, it appears to be an Iffy thing at this point, right?
Walla- Stretching. The missing piece to the plantar fasciitis puzzel.
My last year in practice, I began prescribing a DynaSplint ® device. This splint holds the foot and ankle at a position of stretch which causes the blood vessels to dilate and allows more blood flow in, and lets the stagnate blood flow out - not rocket science. My patients had to comply for 5 hours ,[cumulatively], per day. Those that did, it was a miracle. Those that did not were so-so.
There's another options.
1.Get a 3 foot heavy - black rubber, bungee cord. Place it under the ball of your foot and pull back with your hands. Increase the pressure and push your foot down against the resistance. Do both feet so there isn't an imbalance. Stretch for 3 to 5 minutes per foot as many times a day as you can.
2. Stretch as in #1, before you get out of bed in the morning.
3. Put your shoes on, and lace them up, before you hit the floor in the morning. This gives your foot some protection.
While sleeping, you're body is in the healing mode. When you arise, you can undo what has been heeling the past 8 hours, so - be careful!
Do not walk without your best shoes on. Wear the same shows that offer the best comfort.
4. While sitting at your computer, roll your foot - heel and arch over a golf ball. Do both feet.
5. Get some over the counter arch supports such as Super Feet, or Spenco.
6. Get your partner to do some joint mobilization on your feet. -See video on You Tube soon.
7. Get your partner to tape your arches. - See tutorial in the video tab.
8. Have your partner hold onto your heels and lean back while you are laying on your back. This will stretch your fascia from head to toe. Do for a minimum of 3 to 5 minutes.
9. Replace any shoes that the heels are worn down on the outer side.
HMO HELP - Not Health Maintenance Organization.
Health Maintenance Options from A to Z.
Bowen - see video
1. Get 3 Bowen sessions a week apart. www.bowentherapyonline.com for info and a link to a Bowen directory.
3. Myofascial Release and Cranio Sacral therapies can help also.
Simple to interventional
MENS - electrical stimulation
Joint mobilization and manipulation - see video
Medial calcaneal neurectomy
Plantar fascial release
1. MENS micro current therapy aids in cell stimulation for healing.
2. Find a podiatrist who will strap your arch - I will provide a tutorial on how to do so on YouTube. And then, get some orthotics, once your pain has subsided.. This works, almost every time.
3. Find a podiatrist or chiropractor who does foot manipulations. Activators ® work wonders.
4. Find a podiatrist who; has an in house ultrasound, will place a TENS unit in proximity to the heel to reduce injection pain, place local anesthetic around the Calcaneal nerve, before injecting the cortisone, and guides the needle into the appropriate spot with the ultrasound.
5. My surgery of choice was the per cutaneous technique when all else failed. It is the least invasive of the procedures. Recovery time is much shorter and complications are rare. I only had one mishap out of hundreds of procedures I performed with that technique
In closing, I'll tell you about one of my favorites.
One of my patients who I had treated off and on for about 3 years for plantar fasciitis, came in for her semi-annual cortisone injection. I had tried all of the other standards of care for her, except surgery. When I informed her about Bowen, and that there was a chance it could relieve her pain instead of the injection, she quickly agreed to it. This was about 2 months after I had taken my 1st Bowen workshop in January, 1995. At this point, I was still referring to my cheat sheets which helped me to do the sequences without omissions or errors.
Lorna was a very large lady, about 260 pounds. Muscle mass was very large and taut, beneath gobs of adipose tissue. She was wearing a dress, which inhibited my doing the pelvis and hamstrings procedures properly. So, I did the best as I could. I probably did my full body sequence for her, [BRP 1, BRP, 2, BRP 3, KIDNEY, LOWER RESPIRATORY, HAMSTRINGS, ANTERIOR PELVIS, KNEE, ANKLE, UPPER RESPIRATORY, AND TMJ]. I do not remember if I did coccyx or sacral procedures, probably not on that 1st session. When I finished up with her, I said, “Rest for a couple minutes, the get up and walk around a minute or two before you put your shoes back on. I will see you before you leave”. While I was in Podiatry room 2 seeing a patient, I heard a yell from the back of the office by Lorna, “Yahoo!!” I got up and went back to the Bowen room and asked, “If everything was okay?” She said, “Yeah. I got up to walk over to your desk to get my glasses and the pain is completely gone. Wow!!”
We hired Lorna shortly after to clean our offices once a week. When I said, “Goodbye”, upon retiring in 2006, she was still pain free. I never treated her one time with any modality since that day in March, 1995.