The heel bone (calcaneus) is the largest bone in the foot. This strong bone supports the body’s total weight and is responsible for absorbing the daily stress placed on the feet, making it susceptible to various heel pain and disorders.
Heel pain is also associated with an important ligament of the foot called the plantar fascia. The plantar fascia is attached to the bottom of the heel and extends up to the toes to create and support the arch of the foot. Should the arch flatten due to stress, the plantar fascia stretches beyond its limit (sometimes tearing or rupturing) and pulls on the heel, causing great discomfort or a condition known as plantar fasciitis.
Patients with heel pain often describe the pain as ” stepping on a spur or thorn”, thus the name heel spur. X-rays are often taken and reveal a “bony spur” that has formed at the point where the calcaneus attaches to the plantar fascia. Every step becomes a painful experience and surgical intervention is often necessary to remove the spur and alleviate the pain. Additional physical factors that contribute to heel pain include flat feet, high arches, and tight calf muscles. Significant weight gain, high impact athletic activities, and extended periods of walking or standing can also cause heel pain to flare up.
Several treatment options are recommended for heel pain, including steroid or cortisone injections, anti-inflammatory medications, heel cups and cushions, and orthotic therapy. Soaking in warm water with Epsom salts provides temporary relief. Your podiatrist may also recommend some exercises to help stretch the calf muscles. In severe cases, surgical removal of the heel spur is the only option.
When conservative treatments fail to offer relief, Dr. Toback may perform a procedure called an endoscopic plantar fasciotomy. During this procedure, a small instrument called an arthroscope is inserted into the foot to surgically release the tight tendon where it attaches to the heel bone. Two small incisions are made on either side of the heel. Through one opening, the arthroscope is attached to a small camera to allow the podiatrist to see the inflamed tendon on a TV. Monitor. Through the other opening, small tools are utilized to make a tiny cut in the tendon, thus releasing the tension by allowing the tendon to lengthen, furthermore relieving the tension on the heel spur. The actual heel spur is not removed.
Endoscopic surgery is the newest and best course of treatment. The incisions are very small and consequently, there is less invasive work and discomfort. The procedure is performed in an outpatient surgical center and no hospital stay is required. The procedure itself takes about 15 minutes and the patient will begin walking immediately. Minimal loss of work is incurred.
Older, traditional methods of heel spur surgery required a large surgical incision across the inner side of the heel and a hospital stay was required. A painful recovery generally lasted 4-6 weeks, making it very difficult to return to work. Endoscopic surgery is truly one of the many great advances made in modern medicine.
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