FOOT & ANKLE PAIN

HEEL PAIN - PLANTAR FASCIITIS - HEEL SPURS

WHAT CAUSES HEEL PAIN & PLANTAR FASCIITIS?

Heel pain is one of the leading causes that patients visit Dr. Conway McLean to have treated. Plantar fasciitis (or heel pain) is commonly traced to an inflammation on the bottom of the foot. Dr. McLean can evaluate your arch pain, and may prescribe customized shoe inserts called orthotics to help alleviate the pain you are experiencing.

Plantar fasciitis is caused by inflammation of the connective tissue that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Also called “heel spur syndrome,” the condition can usually be successfully treated with conservative measures such as use of shockwave therapy, anti-inflammatory medications and ice packs, stretching exercises, orthotic devices, and physical therapy.

ACHILLES TENDON PROBLEMS

THE PAIN & WEAKNESS OF THE ACHILLES HEEL

We all have our strengths and weaknesses. Be it psychological or physical, we can’t all be good at everything. But this is quite different from having an Achilles heel. This term can refer to an individual’s weaknesses, or, in contrast, to having pain in the back of the heel or ankle. That’s the kind of weakness that can keep someone from moving freely, walking well, and enjoying life.

The Achilles tendon is the largest, toughest, strongest tendon in the body. The tendon can receive stress equaling almost 4 times body weight during walking, and nearly 8 times that when running. The tendon has a very poor blood supply several inches above its site of attachment into the foot, so this is frequently the site where problems occur, which can bring pain with every step. This can be due to excessive strain on the tendon, such as occurs with high impact activities, or a single traumatic event. Additionally, overuse of the tendon can lead to a whole different set of problems.

Inflammation of the Achilles tendon sheath is called Achilles tendinitis, while Achilles tendinosis is the soreness or stiffness of the tendon itself, and is generally due to overuse. Inflammation was thought to be the cause of most tendon pain until the late 1990s, when scientists discovered there was no evidence of inflammation in many cases. Tendinosis is a degenerative condition, in which the tendon becomes more susceptible to serious damage. Differentiating between the two is important, but is not always obvious. To further confuse the issue, the primary problem may be found where the tendon attaches to the heel bone, a condition called Achilles enthesitis. Often, this problem is due to foot mechanics, leading to excessive motion of the heel bone against the tendon.

Causes of Achilles pain are many, and will determine where the pain originates, as well as what type of pain the sufferer will have. Over-use injuries are common, especially with the “weekend warrior”. Using worn out shoes, or the wrong kind of shoe, can allow excessive motion of the heel, which will tend to physically irritate the tendon attachment. Many treatments can reduce the inflammation, but controlling heel motion is the key to this type of problem.

Often, finding a solution is not simply a matter of buying a new pair of shoes. The treatment program for each of these conditions varies greatly, but some tried-and-true methods are still relied upon. Stretching exercises are the most basic and obvious therapy, and can have extremely beneficial effect, if the right kind is performed. Various physical therapy exercises and treatments have been found helpful, including such technologies as electric stimulation and therapeutic ultrasound.  Prolotherapy is a technique that involves the injection of a sclerosing agent, which leads to the proliferation of new tissue, and thus, healing.

Modern technology has obviously affected medicine profoundly, and this includes treatment of tendon pathologies. Much research has been done into using light for therapeutic purposes, with musculo-skeletal conditions greatly benefitting. Cold lasers and infrared light therapy have both been helpful for various tendon problems. Therapeutic shockwave devices, first used to break up kidney stones, have been used to great effect on Achilles conditions. Other techniques that have been gaining in popularity include the injection of platelets obtained from one’s own blood, and stem cells obtained from embryonic tissue, a treatment that seems especially beneficial.

The effects of inflammation consist of more than “just” pain. When the biochemical process of inflammation goes on for too long, and becomes chronic, tissues become weakened, and can lead to tearing of the structure. When this happens to the Achilles, surgery is the only option. This means a long recovery, with minimal weight bearing early on in the recovery process. In addition, do not belittle the effects on gait of chronic pain. A variety of painful problems can result, including knee, hip, or back pain. Certainly, many sufferers of Achilles tendonitis (or tendinosis) know frustration, due to a lack of improvement. But many options exist, both old and new.

Persistence may be the key, along with getting the right diagnosis, and, of course, the right treatment. Just don’t live with pain, contact us today!

CHRONIC FOOT OR ANKLE PAIN

Quality of life is a broad term, dependent on many factors, and influenced by even more. Definitions vary, but all can agree that certain things have a tremendous effect on one’s quality of life. Obviously, pain is a big one. The study of pain is on-going, and though much has been learned, too often, our usual methods of pain relief amount to a band-aid.

Many recent studies have shown that persistent pain exerts a profound effect on many of the body’s systems, including endocrine, cardiovascular, neurologic, immune and musculo-skeletal systems. The physiologic effects are significant, while the psychologic consequences can be devastating. This isn’t simply that one becomes upset about living with chronic pain, understandable as that would be. Many studies have shown that the actual wiring in the brain is altered by chronic pain, making the brain more susceptible to seemingly unrelated problems such as depression, anxiety, lack of sleep and trouble focusing.

The musculo-skeletal system (the muscles, tendons, ligaments and bones) will undergo “deconditioning”. This means that the muscles will atrophy, and contractures can develop. The individual so affected will tend to splint the part, meaning they will attempt not to use the painful extremity, worsening the atrophy.

But many new weapons exist in the fight against chronic pain. Although most practitioners typically will utilize narcotics initially, to treat an un-resolving condition, many other options exist to treat chronic pain. At this point, many readers may be wondering, isn’t the best way to treat these problems by resolving the condition that is causing the pain? This would seem the obvious solution.  And sometimes, not enough is done to achieve this, but some afflictions are beyond our abilities to resolve.

A common strategy is to gradually convert a patient who is suffering with chronic pain, from regular use of a narcotic pain reliever to one of the non-opioid pain medications. Some of the most successful from this group are medications originally created for depression, but we have found them quite beneficial at treating long-lasting pain syndromes. Although they can have side effects, they don’t have some of those associated with narcotics, specifically constipation, respiratory depression and addiction.

There are non-pharmaceutical methods of treating a chronically painful medical condition. Transcutaneous electrical nerve stimulation, aka TENS, has been around for years, but continues to be a valuable and safe method of treating pain. Although it is not therapeutic (does not improve the condition), it has the ability to block the pain signal traveling to the brain. One of the best aspects of TENS is that it has no side effects or complications, but the benefits vary greatly.

Not many physicians will recommend it, but some individuals find significant improvement in their state of mind by undergoing meditative therapies, or hypnosis. Great improvements can be experienced by learning how to deal with the pain, emotionally and psychologically. To some, this approach sounds silly, but to the sufferer, this can give them the tools to deal better with their affliction.

A pain management physician interviewed for this article extolled the benefits of implantable spinal cord stimulators. These devices are surgically placed along the spine to control or mask the pain signals. They are not appropriate for all conditions, and some find them distinctly unpleasant, but they can be quite helpful. Apparently, a new device is coming to market soon, which will improve its tolerability, and effectiveness.

Compounding is another option. This is not a new method of pain control, but improvements over the last decade have made it a made it a much more viable and successful treatment. Compounding consists of the topical application of a cream, the vehicle, which has been mixed with various appropriate drugs. Because only a certain amount of the drug is absorbed, powerful medications can be used, sometimes ones that are too powerful for internal administration.

Addiction to narcotics is actually quite rare, but the fear remains. Even without addiction, other complications can occur with chronic use. Clearly, alternative treatments exist, although they vary in their effectiveness. And, of course, it depends on the nature of the problem. But living with chronic pain is not an option; the effects can be debilitating. Your quality of life will most certainly depend on it. Schedule an appointment with our practice Superior Foot & Ankle Centers today for a complete evaluation!