Posterior Heel Pain
Heel pain along the back of the heel can be very debilitating. This type of heel pain can be very frustrating to treat for both the patient and also the physician. Dr. Eric Silvers and the staff at Advanced Foot and Ankle Center have successfully treated posterior heel pain (heel pain to the back of the heel) for over 14 years.
Some causes of posterior heel pain can be trauma that results in a fracture or a boney bruise with or without inflammation to the Achilles tendon (tendonitis). The pain can also be due to mechanical problems such as a tight heel cord (Achilles tendon). In addition, bone spurs that result from long term pulling (traction) of the Achilles tendon can develop and produce a bump or prominence along the back of the heel. Some types of arthritis can also cause spurs to the heel.
Many times bone spurs along the back of the heel are not painful. When they do become painful, the experts at Advanced Foot and Ankle Center in McKinney and Prosper, Texas can help you find relief. Our treatment plans for posterior heel pain are conservative yet aggressive. Dr. Silvers will evaluate your heel pain both clinically and radiographically (x-rays, CT and/or MRI if needed). He may choose to have some blood work taken after conducting a history and physical examination. Some conservative treatment options include heel lifts, walking boots, casting, oral steroids, oral or topical anti inflammatories, shoe modifications, physical therapy, and altering activity.
If a course of aggressive conservative treatment fails after 3-9 months, then surgical options for patients who are surgical candidates may be explored. Such surgical treatments involve addressing the heel spur and the Achilles tendon. If Dr. Silvers finds that the Achilles tendon is short or tight, he will suggest lengthening in addition to removing the heel spur. Dr. Silvers uses the most advanced techniques for treating heel spurs along the back of the heel. Today, Dr. Silvers utilized the Arthrex Speed Bridge System. “I like the Speed Bridge because it provides a stable and strong means of reattaching the Achilles tendon to the heel after bone spur resection. In the 14 years since I have been performing poserior heel spur surgery, I have yet to find an anchoring system that matches up to the Arthrex Speed Bridge. The speed bridge is nice not only that if utilizes 4-3.5 mm bioabsorbable anchors, but it is also a knotless system. That means that we no longer have to bury knots within the tendon as it is reattached to the heel bone. In addition, the criss crossing of the sutures attached to the anchors provides a wide surface area of compression to the Achilles tendon and the heel bone.”
Despite the great advancements to reattaching the Achilles tendon to the heel bone, recovery does take a minimum of 6 weeks of non weight bearing on the involved foot. After the six week period, another 2-6 weeks of utilizing a walking boot is required.
If you suffer from posterior heel pain (pain along the back of the heel) call Advanced Foot and Ankle Center to schedule an appointment to see Dr. Eric Silvers. Dr. Silvers has patients that have come to Texas from all over the country to see him including, Florida, California, Arkansas, Oklahoma, Michigan, Illinois, just to name a few.
You can reach us by calling 972-542-2155. Our friendly staff is sympathetic to your heel pain needs and will do their best to get you into our office for a personalized consultation with Dr. Silvers directly.
Infracalcaneal Exostosis
An infracalcaneal exostosis is term that describe a large bony prominence or spur on the bottom of the heel bone or calcaneus. In some patients, this bone spur can actually be large enough to to be felt on the bottom of the heel.
The bone spur is caused by traction or pulling on the heel bone or calcaneus by tiny muscles on the bottom of the foot. Many people correlate “heel spurs” with plantar fasciitis. This is a false statement. The plantar fascia in actuality, inserts just lateral to the plantar heel spur. It is the small musculature that causes formation of the bone spur. The reason why the muscles do this is secondary to abnormal and uncontrolled foot mechanics.
Most patients have 1 – 1.5 inches of fat pad on the bottom of the heel that aids in cushioning and shock absorption for the calcaneus. In older patients who have experienced atrophy or thinning of the fat pad, the bone spur can be prominent and very painful.
Treatment includes cushioning of the infracalcaneal exostosis, wearing appropriate shoe gear to soften the impact of the heel with walking or running. Although not available in our office, some plastic surgeons and aestheticians are offering collagen injection therapy to the plantar aspect of the heel to aid in cushioning. It must be known that this is only a temporary solution and often requires multiple periodic injections.
For those patient who cannot find relief cushioning, padding or shoe therapy, surgery is a viable option. Surgery involves removing the plantar heel spur or infracalcaneal exostosis and making the bottom surface of the heel bone flat and smooth. A extended period of non-weightbearing is suggested due to possible risk of stress fracture with early walking following the surgery.
If you have a prominent heel spur on the bottom of the heel, please visit our office for a clinical evaluation. Call 972-542-2155 for an appointment today.
Does A Heel Spur Cause Plantar Fasciitis?
When people have plantar fasciitis or pain on the bottom of the heel or arch, they may feel a stabbing or sharp pain. Many people think they have a large heel spur tring to poke out the bottom of their heel.
In actuality, not all people who have plantar fasciitis have a heel spur. You must not correlate the size of a heel spur with the amount of heel pain present. Many patients walk into our office everyday with plantar fasciitis and have no remnants of a heel spur. Many patients walk into the office with a huge heel spur and have absolutely no heel pain. But there are people who fall in the middle and have plantar fasciitis and do have a heel spur.
Some think that the heel spur develops because of traction or pulling on the bone by the plantar fascia. This is completely false. In the foot, there are dozens of small tiny muscles, especially on the bottom of the foot. Research has shown that if a patient has a heel spur and dissection was performed on the patient’s foot at the site of the heel spur, it would show that the plantar fascia does not insert on the heel spur. Instead, about 2-3 tiny muscles in the bottom of the foot originate from heel spur. The plantar fascia actually inserts on the bottom of the heel bone just lateral or below the heel spur. Poor foot mechanics can cause greater muscle activity inside the foot and lead to the development of the heel spur.
What are the 2 most common things that can happen if the heel spur is taken out?
1. Possible stress fracture of the heel bone
2. Deep space infection in the surgical area
Overall, heel spur removal is seldom necessary in treating pain associated with plantar fasciitis. There is no correlation of the heel spur with the plantar fascia from an anatomic perspective. Many people get better from plantar fasciitis with conservative therapy while the heel spur remains present. According to the latest research, there is no evidence to support routine surgical removal heel spurs during the course of a plantar fascia surgery.
If you have plantar fasciitis and you are interested in having surgery on the foot, please come see Dr. Kory Williams or Dr. Eric Silvers at Advanced Foot & Ankle Center in McKinney, TX and Prosper, TX.
Call 972-542-2155 for an appointment today.
Crazy Shoes: Are These For Real?
I thought you guys might get a laugh when looking at these absurd shoes.
Enjoy! Have a great day!
P.S. – These are not recommended to wear.
~Dr. Williams
Extracorporeal Shock Wave Treatment for Heel Pain
A revolutionary new treatment for plantar fasciitis has arrived and is now offered at McKinney Foot and Ankle Center. Many people suffer from the classic symptoms of plantar fasciitis. These symptoms typically are heel pain the first few steps in the morning and/or after rest. This pain usually subsides some after walking for five to ten minutes. As the condition progresses, patients may experience heel pain late in the day as well. Extracorporeal Shock Wave is now FDA approved to treat plantar fasciitis.
“Extracorporeal” means “outside the body.” Shock waves are created by very strong acoustic (sound) energy. The ESW treatment is preformed with a device called the OssaTron. The OssaTron is a shock wave generator very similar to the shock wave devices used to treat kidney stones without surgery (Lithotripsy). The shock waves are created by a spark plug that is enclosed in a soft plastic dome filled with water. During ESW treatment, this dome is placed close against the heel so that the shock waves pass through the dome into the heel. ESW is a non-invasive way of treating heel pain. There are no incisions, stitches or dressings associated with ESW treatment. The day of the ESW treatment: Dr. Silvers will probably ask you to come to the surgery center a few hours before your ESW treatment is scheduled. You should wear shorts or loose fitting clothing that can easily be rolled up to the knee of your affected leg. Otherwise, you may be asked to change from your own clothes into a hospital gown. The staff may take your temperature, pulse and blood pressure and ask you some questions about your general health. They also will make sure you have signed a consent form for the ESW treatment. The ESW treatment may cause some discomfort, so an anesthetic is commonly given before the procedure. Usually, this is a local anesthetic or a regional anesthetic called a heel block. During the ESW treatment, you will be asked to rest comfortably on your back while Dr. Silvers holds your foot up to the OssaTron shock head. An ESW treatment for chronic proximal plantar faciitis usually takes about 30 minutes. The ESW treatment is performed as an outpatient procedure. No overnight hospital is necessary. After the ESW treatment: Immediately after treatment, you will stay at the hospital or surgery center until the anesthetic wears off enough that it is safe for you to walk. Dr. Silvers will probably ask you to restrict “stressful activity” involving the treated foot for four weeks after treatment. “Stressful activity” may include running or jogging, doing heavy housework or yard work, and participating in sports. Some patients need a mild pain medication following ESW treatment. Although some patients feel immediate relief from pain after the ESW treatment, it is more common for it to take up to six weeks for pain relief to begin. Dr Silvers will ask you to return to the office for a follow up visit after ESW treatment. How can I get more information about ESW treatment for heel pain? Talk to Dr. Silvers. In order to use the OssaTron to treat chronic proximal plantar faciitis, Dr. Silvers had to complete a specialized training program. The training program not only allowed Dr. Silvers to learn how to perform the ESW treatment, but it also included information about shock wave energy in general, and information from the OssaTron clinical study. Therefore, Dr. Silvers is the best person to talk with if you have any questions or concerns about ESW treatment for chronic proximal plantar faciitis with the OssaTron. Other treatments available for treating chronic proximal plantar faciitis: Many other people get better after trying one or several conservative treatments, which include:
In difficult cases of chronic proximal plantar fasciitis, open or arthoscopic surgery may be performed. Who should consider having ESW treatment for proximal plantar fasciitis? ESW treatment with the OssaTron is for patients who have had heel pain for at least six months and who have tried other methods for treating their heel pain. In the OssaTron clinical study, the treated patients had failed to respond to at least three attempts at conservative treatment: two prior courses of non-invasive treatment, including physical therapy and the use of an orthotic device; and one prior course of pharmacological treatment. ESW treatment with the OssaTron is for patients who can tolerate anesthesia prior to the ESW procedure. ESW treatment with the OssaTron is painful. ESW treatment with the OssaTron is for patients who can tolerate hearing protection to reduce the risk of hearing impairment due to the sound of the OssaTron. Contraindications:
Because the OssaTron has not been tested on people who have the following conditions, its effect, safety, and effectiveness on someone who has one of the following conditions is unknown:
Dr. Silvers can provide you with additional information about these and other conditions and how they might affect the decision to perform ESW treatment. Side Effect and Complications:
If you have any questions about ESW or if you would like to schedule an appointment with Dr. Silvers, please call McKinney Foot and Ankle Center at (972) 542-2155. |
