What is the biggest mistake most doctors make once a patient comes in with heel pain?
The wrong diagnosis. I am shocked when patients come to see me for a second opinion with heel pain and they have been given the diagnosis of Plantar Fasciitis. When I ask them how the doctor arrived at that diagnosis I often hear “I don’t know, I just went in and told that Dr. I had heel pain and he told me that I have Plantar Fasciitis”. When I ask if the doctor did a careful exam on the foot I frequently hear “No, he didn’t even touch my foot”. There are several causes of heel pain and a successful treatment plan needs, first of all, the right diagnosis.
What is different about how we make the diagnosis of Plantar Fasciitis?
The protocol we use for making the diagnosis of Plantar Fasciitis includes a 6 point exam on your lower extremity. We use an x-ray image as well as an ultrasound image to make the correct diagnosis. Virtually half the patients we examine have more going on than just Plantar Fasciitis and about 20% of them do not have Plantar Fasciitis at all.
How do most doctors treat heel pain?
Most doctors treat heel pain by prescribing medication and physical therapy. Although these can be helpful, they usually do not solve the problem. Also, they take time. Who has that nowadays? Prescribing medication and physical therapy is 1940s medicine. It can work...sometimes. But frequently, the patient just gives up and lives with the pain.
What about the injection? I’ve heard horror stories!
We use a technique to help decrease the pain of the injections. The vast majority of our patients state they have felt significantly less pain with our injections than injections they received elsewhere. So don’t worry, most people are pleasantly surprised by the degree of pain they have with our injections.
How do we treat Plantar Fasciitis at Next Step Foot and Ankle Clinic?
If you truly have Plantar Fasciitis, we have a wonderful treatment plan that usually can get you feeling better fairly quickly (a few days). We follow that up with a long-term plan to heal the damaged tissue. This is all determined by how well you are doing with our therapies. On your first visit our goal is to have you 85-90% better in 2 days. To do that we do several things all at once. This approach has been very successful for our patients.
Advanced therapies for Plantar Fasciitis available at The Next Step Foot and Ankle Clinic:
1: Shockwave Therapy: Shockwave Therapy, if appropriately applied, has been shown to be as effective as surgery. It does not interrupt your activities of daily living, has very quick results in general, and can help induce long-term healing to the affected tissues.
2: Injectable extracellular matrix (solutions): Frequently, heel pain has been present for a long time or the patient is experiencing significant degeneration in the ligament (plantar fascia). This treatment can provide a structural repair model for the tissue to heal itself. This is often used in conjunction with shockwave therapy. Also, we occasionally use amnion injections to help tissue heal.
3: Joint Contractures: We also address possible joint contractures that can contribute substantially to heel pain. We have specialized equipment that we dispense to the patient that can treat these conditions and promote healing without interrupting the patient’s lifestyle.
4: Great over-the-counter arch supports for heel pain. We have searched long and hard for an arch support that is inexpensive and effective for heel pain. We feel we have the answer for most of our patients. If those don’t work...
5: Orthotic Therapy: Almost every podiatrist prescribes orthotics. Unfortunately, the vast majority of orthotics dispensed are nothing more than expensive arch supports and do not take into consideration what the patient’s foot is like. We do a good exam so when you get your orthotic it really controls your foot and decreases stress on the plantar fascia.
6: Minimally Invasive Surgery: Sometimes, nothing else works and surgery is necessary. We use many different types of surgical approaches to heel pain. One of them that is very helpful is a percutaneous procedure where the incision is about as wide as a pencil lead. This results in a very quick return to work and activity.
7: Laser Therapy: We have the gold standard in laser therapy...MLS laser. It is a robotic computerized laser that provides multiple benefits: Anti-inflammatory, analgesic, accelerated tissue repair, and improved vascularity are just a few.
9: Home exercises: You will receive instructions on simple, easy to do home therapy exercises to help your plantar fascia heal itself.
10: Nutritional support: We frequently recommend nutritional support to help the damaged tissues heal.
11: Any combination of the above! By combining these modalities we can magnify the effects.