Bill Klaproth (Host): Plantar fasciitis is one of the most common causes of heel pain. Who is most at risk and how can you treat it? Here to tell us is Dr. Will Whiteside a physician at Tidelands Health. Dr. Whiteside, thanks for being on with us today. What happens in the heel that causes this sharp, stabbing pain of plantar fasciitis?

Dr. Will Whiteside (Guest): It’s real common. It’s one of the most common things we see. Basically, it’s an irritation of the band of tissue that runs from the bottom part of your heel all the way to your toes. It’s just an inflammatory process that can be very debilitating.
Bill: Who is most at risk for this?

Dr. Whiteside: The number one person at risk is typically runners, but it’s also very common in people who just stand on their feet a lot. It can happen to the everyday individual.

Bill: Is this something that can go away on its own over time?

Dr. Whiteside: Yes, it is. It just takes a long time is one of the key things that I try to emphasize to people. It can take up to a year before it’s completely resolved and that’s after a year of appropriate treatment.

Bill: Oh, my.

Dr. Whiteside: Yes.

Bill: That would seem like a long time to deal with pain like that. If somebody has a mild case or they do have it, are there home treatments that you coach them on to try first?

Dr. Whiteside: Yes, there certainly are. It’s real simple. Essentially, it’s a simple plan but it’s difficult to follow. But, essentially, it’s calf and Achilles tendon stretches and you can do those at home. I usually give people a hand out but sometimes I send them to formal physical therapy to help guide them initially. Other things you can do is typical anti-inflammatories like Motrin, Advil, Aleve – those type of things--and some over the counter arch supports are your first line measures.

Bill: When is it time for someone to see a doctor? At what point in their pain level should they come see you?

Dr. Whiteside: If a heel pain doesn’t go away in about a month and you’ve tried some of the home remedies and you’ve looked at things over the internet and you think this is what you have or, even if it’s not and it doesn’t go away in about a month or its debilitating and you can’t walk, then I typically would advise somebody to come and be seen.

Bill: That would be a good one. That seems like that would be a good time to come see you.

Dr. Whiteside: It would

Bill: What do you look for in a diagnosis to rule out that it’s something else? What are you looking for?

Dr. Whiteside: A lot of times I get foot x-rays in my office. It can help rule out a stress fracture of your heel bone which can be confused sometimes. There’s also some nerve entrapments that can present with heel pain. A lot of it’s the diagnosis that you make by talking to the patient and doing a good physical exam.

Bill: After you determine that it is plantar fasciitis, what is the normal treatment? You talked about Motrin, Advil, a shoe support but after that, what is the next phase of treatment?

Dr. Whiteside: If they don’t get better with home remedies, like I said before, I usually send them to formal physical therapy. If they’ve tried stretching on their own, and all that, I send them to formal physical therapy where they can essentially guide you in stretches. Some do manual massage techniques. There’s also a technique called dry needling, which is essentially similar to acupuncture. That initiates an inflammatory and healing response in the heel. That’s kind of your next step and then after that you can get a cortisone injection into your heel. That’s something we do in the office. There’s also custom arch supports that you can go get or I have an orthoptist, or somebody that makes inserts, look at your feet make those. That can cost $300 or so with the custom ones. There’s also a splint people can wear at night that keeps your foot stretched out. Those are your second line measures as you’re going along in the treatment phase for this.

Bill: Is there surgery for this, too? Would that be your last line of treatment?

Dr. Whiteside: Right it is. I try to do surgery only after they’ve been doing a year of treatment because most people – up to 90% – do get better but it can take up to a year. There is certainly surgery for that and several different varieties. One is where you release the plantar fasciitis right at the heel. There’s another type of surgery where you release the tissue that surrounds the calf muscle, more inside the calf area, that can decrease the pressure on the heel. Those are your surgical options but, typically, that is only necessary after about a year. But, again, 90% of people get better without surgery. It’s one of your last resorts but surgery can be affective.

Bill: What is a recovery timeframe with conservative treatments?

Dr. Whiteside: Usually, you can notice a difference in about a month. If somebody is consistently doing their stretches for their calf and Achilles tendon. But, again, it can take a lot longer than that – it can take about a year before you fully recover. If you’re consistently doing your stretches, you can feel a difference by about a month but, again, it takes a good bit of time. It’s a problem that comes on quick but it’s just a long recovery from something like that.

Bill: Is this something you can get rid of completely?

Dr. Whiteside: Yes, it is. It is something you can get rid of but it’s also something that can come back. It’s related to having tight calves and Achilles muscles, essentially, and if you’re up on your feet all the time, it can come back. A lot of times, it can be prevented with a good stretching program.

Bill: That was my next question. If you’ve had it once, you’re at higher risk for reoccurrence. You just said that it is. Once you have it, you probably have to manage yourself to try to avoid getting it again.

Dr. Whiteside: Right. Exactly. Those are the kinds of things you have to remember. It’s kind of like a maintenance program for your car. You have to do your stretches when you get up out of bed every morning and maybe at lunch and things like that. A couple of other things that I emphasize to my patients is keeping a healthy weight; wear good, supportive shoes; and don’t overdo it, especially when you’re running or playing sports or trying to do too much on the weekend. You have to gradually get into those kind of activities.

Bill: For someone who has never had this before, is it a good idea to implement some of the exercises and lifestyle changes that you just talked about to ensure that you don’t get this?

Dr. Whiteside: Yes, I think in America one of the big problems is everybody’s weight and, obviously, keeping a healthy weight is good for your feet just like it is for your heart and everything else. That’s one thing – the less weight you’re carrying around on your body there it transfers less weight onto your feet. That keeps you healthy from that aspect. The other thing is a good stretching program for your calf and Achilles and those things can help you keep things at bay.

Bill: Especially, for runners, then, I would take it. It seems like they’re more susceptible to this. A runner would really want to pay attention to these stretching exercises.

Dr. Whiteside: Right. They just have so much impact on their heel with heel strike and everything else as their running. They are at risk just because they put a lot more impact on their plantar fasciitis than the everyday person but it can occur in those folks that work all day long on hard surfaces, too. Just the nature of the job.

Bill: Absolutely. Dr. Whiteside, is there anything that I haven’t asked you that we should know about plantar fasciitis?

Dr. Whiteside: I think one of the main things that I try to emphasize to people is that you should try treatments for at least six months before you consider surgery, if not a year, which is my formal recommendation. There’s risks and benefits to surgery, of course, but usually it gets better but it can take up to a year. That’s what I emphasize to my patients the first time I see them for this. It’s very common. One in ten people have this. Usually, I tell them talk to their friends or relatives, sports partners, because somebody’s had it. They call it “heel pain”. But it’s very common. It can get better.

Bill: That is very good news, that’s for sure. Dr. Whiteside, thank you so much for your time today. Why should someone choose Tidelands for their orthopedic needs?

Dr. Whiteside: I think we have a good comprehensive orthopedic care team. We take a patient centered approach. We were actually recently named as one of America’s 100 best orthopedic surgery centers by Health Grades.

Bill: That’s fantastic. Always good stuff at Tidelands and we appreciate your time today. For more information about Tidelands Health physicians, services and facilities visit TidelandsHealth.org. That’s TidelandsHealth.org. This is Better Health Radio. I’m Bill Klaproth. Thanks or listening.