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Foot and Heel Pain Problematic for Many Raleigh, Chapel, Durham, Cary and Other Triangle Patients

An extremely common malady in the lower leg is "foot / heel pain," also known in some cases as Achilles tendonitis syndrome This complaint is typically generalized to this description yet in order to treat the symptoms and cause it is first important to attempt to gain an understanding of the underlying condition of foot / heel pain and properly diagnose the complaint.

Foot / heel pain can occur for varying reasons and actually be located in different areas of the foot region although the patient will typically describe the complaint as a painful heel. Heel pain can be located directly beneath the foot, most commonly on the plantar aspect. Also noted is mid-region foot/arch pain, and pain located along the posterior region of the heel. There may also be times when a nerve that courses down from the lower leg can become entrapped near the ankle/heel area creating complaints of pain.

Description Of Common Variety Of Foot / Heel Pain

Plantar Foot / Heel Pain
Pain on the underneath side of the heel (plantar surface) is the most common type of foot / heel pain complaint. This problem is often referred to as plantar fasciitis, heel spur syndrome, and Achilles tendonitis syndrome, or heel bruise among other terms

This foot / heel pain condition is commonly seen in the population from 20 to 50 years of age with a higher incidence in females and overweight people. Flat footedness is often not a factor in foot / heel pain.

What Are The Complaints of Foot / Heel Pain from
Raleigh, Cary, Garner, Apex and Other Triangle Sufferers?

Typically the normal complaint of foot/heel pain or Achilles tendonitis syndrome will be morning pain upon arising from bed or pain upon arising after any prolonged non weight bearing activity, such as sitting or driving. The foot/heel pain will quickly diminish after a few steps but then returns after later periods of inactivity. Foot/heel pain will be located along the front and inner portion of the heel, usually at the insertion site of the plantar ligament as it inserts into the medial calcaneal (heel bone) tuberosity.

Diagnosis of Plantar Heel pain is primarily clinical in that there are no diagnostic tests that can confirm or deny the actual diagnosis. Clinically pain in the heel can originate from nerve entrapment, lack of blood flow, loss of heel fat pad which is especially noted in the elderly, stress fracture of the calcaneus (heel bone) or localized inflammatory response of the plantar fascia insertion. Heel/bone spurs may also be noted on X-Ray, however it should be noted that not all patients with documented heel spur syndrome are symptomatic and many patients with symptoms do not show evidence of heel spur.

Diagnosis Of Plantar Fasciitis

The clinical diagnosis of plantar fasciitis is the most common related to heel pain. The pain is thought to be caused by micro trauma and tearing of the plantar fascia at its insertion on the heel. This condition is similar to "Tennis Elbow". The majority of plantar fasciitis patients will self resolve within 12 months of onset.

Is There A Treatment for Foot / Heel Pain Or Achilles
Tendonitis Syndrome for Patients in Raleigh, Cary, Durham, Chapel Hill and the Triangle?

Patient education is very important to alleviate concern and frustration on the patient’s part. The initial treatment protocol for Achilles tendonitis syndrome and foot / heel pain should consist of stretching the calf and foot muscles, constant appropriate shoewear with heel cups or arch supports. Anti-inflammatory medications and ice as well as weight loss and activity modification can be very helpful as well.

In the event the initial conservative regimen fails, your physician may consider additional regimen consisting of physical therapy for local modalities such as ice, ultrasound, deep tissue massage, and custom orthotics. Along these lines the condition may need an injection of steroid and anesthetic, casting or night splints.

As a later resort in refractory cases you may consider undergoing non-invasive shock wave therapy or ultimately a surgical release of the plantar fascia. This should only be considered if all treatment options have failed and you have had the condition longer than 12 months.

For more information on how the foot / heel pain specialists at Cary Orthopaedics can help you, contact us today at 919-467-4992 for an appointment!

Cary Orthopaedics serves patients from Raleigh, Garner, Cary, Apex, Holly Springs, Fuquay-Varina, Clayton, Chapel Hill, and Pittsboro, NC.

Treatment Approach for These Causes of Foot Pain

The mechanical relief of stress should be the initial treatment method to alleviate causes of foot pain. This may be done by wearing slightly wider shoe with the use of an insole that provides a metatarsal arch pad to assist in separating the metatarsal bones and weight relieving the affected area. Steroid injections may be the second treatment method although this has not been found to have a high success rate. In the event of failure of conservative methods, surgical excision of the neuroma can be performed with a high success rate measured at 85% in the literature.

Metatarsal Stress Fractures Of The Foot

Fractures of the metatarsals are common and longstanding. First identified in soldiers before the turn of the 20th century and most commonly located in metatarsals 2-4. The history reveals overuse relative to normal activity such as prolonged jumping or running. Mechanically these bones have a lack of mobility and when overstressed ultimately may fracture. Early plain x-rays are usually inconclusive. Bone scan will adequately diagnose this injury.
 

Management Of Stress Fractures Of The Foot

Activity modification is first and foremost. Removing the insulting activity must be implemented. Complete non-weight bearing status is usually not necessary but certainly protected weight bearing is advised. Possibly early short term non-weight bearing status may be ideal and as the initial healing response takes place, pain will be reduced and a boot walker may be used to allow more normal gait. Once healing takes place it will be important to identify the mechanical causes and insure that changes to these stressful factors be addressed.

Occasionally in heavier athletes, surgery may be necessary to insure full healing without recurrence at the fracture site.

For more information on how the foot metatarsalgia specialists at Cary Orthopaedics can help you, contact us today at 919-467-4992 for an appointment!

Cary Orthopaedics serves patients from Raleigh, Garner, Cary, Apex, Holly Springs, Fuquay-Varina, Clayton, Chapel Hill, and Pittsboro, NC.