Top Foot Doctor for Chronic Heel Pain

Foot Pain Treatment for Plantar Fasciitis & More

A couch potato probably takes 1000 to 3000 steps per day while an active person may take 10,000 to 30,000 steps per day. Imagine the plantar fascia being over strained or over stretched with each step and that over stretch taking place 30,000 times a day. The cumulative, repetitive stretching of the plantar fascia begins to take its toll and the plantar fascia reacts by thickening and becoming painful. 

Dr. Ed Davis at South Texas Podiatry coined the term “Treatment Triad” several years ago.  It is a term that describes the long term progress of plantar fasciitis and why different treatments are more effective for different stages of the disease:

1. Acute plantar fasciitis: This involves a "strain" of the fascia from overuse or use of inadequate shoe gear.  It is often self limiting and may be treated via rest, ice massage, anti-inflammatory medication and use of better, more supportive shoe gear. Sonographic exams may demonstrate modest swelling of the fascia.
2. Plantar fasciitis that persists/chronic plantar fasciitis: Plantar fasciitis that persists for more than a few weeks often does so due to chronic repetitive strain. That may be caused by subtalar joint overpronation, midtarsal joint oversupination, functional equinus or poor shoe design. Sonographic examination often demonstrates thickening of the fascia, scar tissue, and sometimes calcification of the fascia. Calcification of the fascia used to be termed "heel spur" syndrome. X-rays are two dimensional representations of the problem leading to that term. The underlying mechanical problems need to be addressed at this stage.
3. "Recalcitrant" plantar fasciitis or plantar fasciosis: Chronic inflammation is not handled well by our bodies. Chronic inflammation in the arteries may lead to atherosclerosis. Chronic inflammation of tendons and ligaments leads to thickening, scar tissue, decrease of tissue flexibility and a reduction in blood circulation. Sonography demonstrates thickening of the fascia with changes in the texture of the ligament. Scar tissue tends to crowd out good tissue.  Neovascularization (the production of new blood vessels) is difficult due to the density of the diseased tissue. This stage had been difficult to treat with one of the main procedures involving the surgical release (cutting) of the fascia. Dr. Davis believes that such surgeries are obsolete due to the availability of ESWTand the Topaz Procedure.

The key to relieving plantar fasciitis in the long term is to stop the repeated over stretching of the fascia in gait. This can be accomplished by a foot specialist making a specialized device called an orthotic that is made from a mold of the foot and functions to hold the foot in a position of minimal stress on the plantar fascia.

There are a number of other treatments like cortisone shots but they are for temporary relief only and can have side effects if used incorrectly. A prescription for physical therapy or massage therapy can also provide temporary relief in a safer fashion. A prescription orthotic is like a prescription eyeglass in that it's efficacy depends on the accuracy of the prescription. Placing one's foot in a foam box to capture its shape only serves to capture the foot in the wrong position. It is up to the foot specialist to position the foot in the corrected position, the position that minimizes strain on the plantar fascia and then capturing that corrected shape with a plaster of Paris mold or with newer technology, a three dimensional optical scanner. The mold or "capture" of the corrected foot shape is then sent to a prescription orthotic laboratory where the orthotic is made. The mold is called a negative cast, so the lab has to pour plaster into the negative cast to make a model of the foot. plastic or graphite is then heat molded to the model to make the orthotic.