Doctor, my heel hurts

This is a com­mon com­plaint heard in a doc­tor’s of­fice. It af­fects men and wo­men, young and old. But what is it? It is most com­monly plantar fas­ciit­is. You may not have heard of this dia­gnos­is. It is more com­monly known as a heel spur. This is an older ter­min­o­logy for the same dia­gnos­is. The reas­on it was called a heel spur was be­cause when the foot is X-rayed, of­ten one sees a spur-like bony pro­jec­tion off of the bot­tom of the heel bone. For many years, this was thought to be the cause of the pain. Sur­gery was of­ten per­formed to re­move the spur. But of­ten, even after re­mov­ing the spur, the pain per­sists.

As ad­vances in medi­cine oc­curred through the years, like ex­amin­ing the tis­sue in the patho­logy lab and ima­ging tech­niques, it was dis­covered that the pain was com­ing from the in­flam­ma­tion of the fas­cia lay­er between the lay­ers of muscles and ten­dons of the foot, not the heel spur it­self. Hence the name change to plantar fas­ciit­is, which lit­er­ally means in­flam­ma­tion of the fas­cia.

Fas­cia is a white sil­very tis­sue between the tis­sues. It is in the en­tire hu­man body. You may see it on chick­en breast, too. It is that white lay­er you peel off the chick­en you get from the gro­cery store. This tis­sue has little blood sup­ply, hence it is of­ten very dif­fi­cult to treat with medi­cines. Treat­ment can vary, and usu­ally a mul­ti­tude of mod­al­it­ies are re­quired to get re­lief.

Anti-in­flam­mat­ory med­ic­a­tions are used along with heat and ice. But stretch­ing the foot and re­mov­ing any­thing that makes the ten­dons tight are very help­ful. Keep­ing the leg calf muscles warm at night while you sleep can re­duce the pain and in­flam­ma­tion. And in most severe cases, a ster­oid in­jec­tion to the heel can be use­ful.

Plantar fas­ciit­is can last a long time and ag­grav­ate or cause oth­er lower ex­tremity dys­func­tion. So if it doesn’t go away, see your doc­tor for the best at­ten­tion and re­lief pos­sible. ••

Jack Tu­masz, D.O., prac­tices fam­ily medi­cine with EPIC Phys­i­cians, 8019 Frank­ford Ave.

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