The Center for Podiatric Care and Sports Medicine

Foot Doctor Thoughts: 3 Surprising Things That May Not Help Your Plantar Fasciitis Pain & Why

Posted by on Tuesday, August 19th, 2014

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The Huffington Post’s Felice Shapiro has seemingly tried it all in an effort to cure the plantar fasciitis heel pain on her left side. Her story sounds similar to what a lot of patients tell us at The Center for Podiatric Care & Sports Medicine. There are many conflicting theories on what does or doesn’t work for heel pain. Just about everyone knows someone else who has had this type of foot pain that afflicts roughly 2 million Americans each year. Even so, it’s difficult to find two foot doctors who feel exactly the same way about this mysterious ailment. Eventually, most people come see us — but only after trying every home remedy in the books. These are our thoughts on the stubbornness of plantar fasciitis and our theories why some common treatments may not be working.

heel pain
What causes heel pain? It’s not merely “inflammation,” as doctors once presumed. The factors may be more complex than you realize. Image Source: Plantar-Fasciitis-ElroFeet.com

Why Plantar Fasciitis Treatments Aren’t Working

We see several different issues with plantar fasciitis treatment in America, as a whole. First of all, not enough diagnostic testing is performed to detect the real root cause of the pain. Insurance companies don’t like paying for it and doctors are trained to quickly offer up solutions for acute pain, rather than delve into the complexities of what constitutes chronic pain.

As a result, many people who complain of “heel pain” are perhaps misdiagnosed. A plantar fascia rupture, for instance, will not respond to conventional plantar fasciitis treatments like cortisone injections, massage and stretching. Instead, treatment relies on immobilization with a removable boot for up to six weeks and NSAID therapy. Tarsal tunnel syndrome and nerve entrapment are other common causes of pain mistaken for plantar fasciitis. In these cases, relief may be found through a minimally invasive surgical procedure that reduces pressure on the afflicted nerve. Be sure to read this article and this article about alternate causes of heel pain.

For the people who do have plantar fasciitis, about 20 percent (usually people who put off early treatment) will go on to develop chronic heel pain that is more unpredictable in responding to various treatments.

Treatment Controversy: 3 Things That May Not Help Your Plantar Fasciitis Pain

Orthotics: Our NYC foot doctor clinics cast people for orthotics all the time. For mild pain, bunion deformity, flat foot, Morton’s neuroma, runner’s knee and high arches, a custom shoe insert may be all that is needed to alleviate the discomfort. There are some heel pain patients with gait abnormalities or feet that have changed form over the years who can benefit from orthotics, but for the most part, it seems that orthotics are over-prescribed for heel pain.

– Cortisone Injections: Cortisone is often administered as a treatment for acute foot pain. It is important to understand that these injections are providing relief by reducing inflammation and improving circulation in the affected area. Yet, Dr. Karim Khan, editor of The British Journal of Sports Medicine, told the NY Times that “Plantar fasciitis does not involve inflammatory cells.” When looking at biopsied fascia tissue from people with chronic plantar fasciitis, they did not find inflammation, which led researchers to speculate that degeneration and weakness was more likely the culprits.  Furthermore, another unrelated study found that patients were 35% more likely to suffer a plantar fascia tear following steroid injections.

Low-Intensity Shockwave Therapy: We treat tendonitis patients with shockwave therapy to great success. For many years, published study after study came out suggesting that shockwave therapy was ineffective for plantar fasciitis treatment. However, the machines and applications were different back in the early 2000s. Today, we are able to use stronger shockwaves on patients, safely and effectively. It is often a step tried in the most severe patients before surgery.

Heel Pain Doctors In NYC Offer Their Expertise

The Center for Podiatric Care & Sports Medicine in Manhattan and Westchester is equipped with MRI and gait analysis technology to get to the root cause of your pain. Our sports medicine specialists look at how the bones, tendons, muscles and joints come together to form your stance, walking and running patterns. Only by looking at the complete picture can we truly offer you the best solution for plantar fasciitis or another cause of heel pain. Our full team of board-certified podiatrists, sports medicine doctors, physical therapists, and surgeons are equipped to provide you with the most comprehensive care.  Book your appointment  today!

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.