Thursday, February 6, 2020

Treatment options for chronic heel pain in runners


Epidemic of Heel Pain in the running population
Heel pain is the most common complaint that we see in our office. The typical ages of complaints of heel pain are between the age of 40 and 60, which is the largest age segment in our population.
There is a growing consensus of opinion that plantar fascitis is best treated non-surgically with the vast majority of patients becoming asymptomatic within twelve months of the onset of symptoms.
During this time of the year many of our patients are training for upcoming races such as the Cooper River Bridge run and various ½ and full Marathons. We would like to discuss our experience with treating heel pain in our running population and state of the art treatments if heel pain is a chronic issue.
PATHOMECHANICS
Contributing factors are tightness of the achilles tendon, overload of the soft tissues, leg length inequality, excessive flattening of the arch, high arched feet, and high impact sports. It is well accepted that the common athlete presenting with heel pain has a medium to high-arched foot.
TREATMENT STRATEGIES FOR THE ATHLETE
In most cases, the goal of the athlete ie. runners is to quickly return to activities to minimize loss of fitness and performance. In our practice we see a high volume of recreational and seasoned competitive runners
1) Assignment to alternative activity
The athlete must be encouraged to maintain cardiovascular fitness during rest from damaging activities that may delay healing. For the running population that suffers from heel pain we try to encourage cross training to lessen the load on the feet. The goal should be assigned to alternative cardiovascular fitness activities that minimize impact and loading on the plantar fascia including stationary cycling, swimming, yoga, pilates, upper body weight machines, and low resistance flat-footed stair master machines These activities help to maintain physical aerobic fitness as well as keep the ligaments and tendons flexible. In addition if you are currently training for a road race lessening the amount of days with respects to your running schedule can be a big help. Personally I was suffering with some minor heel pain and was training for the Charleston ½ Marathon. I changed my frequency of training during the week in which I ran two shorter runs during the week and a longer run on the weekend. This was a three day a week training schedule for 8 weeks and it made all the difference in the world for me.
2) Change and modulation of footwear
Footwear analysis is critical for evaluating athletes with chronic heel pain. The footwear may be a contributory factor and can be utilized as a powerful treatment modality. Athletes should be placed into shoes that have a minimal 1" heel height with a strong stable midfoot shank and relative uninhibited forefoot flexibility. The American Academy of Podiatric Sports Medicine has a list of recommended footwear for the athlete that can be obtained on their web site: www.aapsm.org.It is well recognized that recent trends in athletic footwear have actually predisposed to greater frequency of plantar fascitis due to the fact that athletic shoes have weaker midsoles with newer designs. The popular "two-piece" outsoles with an exposed midsole cause a hinge effect across the midfoot placing excessive strain on the plantar fascia in the running and jumping athlete. These shoes must be eliminated if the injured athlete is wearing them. We recommended around the house to wear oofos or vionic sandals especially if you have hard wood floors.
3) Home therapy
Runners are accustomed to designing and participating in their own training programs. They are willing participants in their own treatment programs. Heel cord stretching is central to the rehabilitation process to decrease load on the plantar fascia and encourage healing. The use of plantar fascia night splints has been well proven to be a treatment adjunct for plantar fascitis by placing the heel cord and the plantar fascia on a sustained static stretch during sleeping hours while preventing the normal contractures that occur in the relaxed foot position during sleep. We recommend runners roll or massage their foot on a golf ball or tennis ball is helpful to improve blood flow and break down adhesions in the injury site.
4) Custom foot orthoses
Intervention with semi-rigid custom foot orthoses has been well proven in many prospective and retrospective studies showing successful outcomes in patients with plantar fascitis. In the athlete, the use of foot orthoses should be considered earlier than in the average sedentary patient because of the fact that the athlete will be subjecting their feet to greater stresses during treatment and certainly after return to activity. Athletic footwear is more amenable to semi-rigid and rigid orthotic therapy than are casual shoes worn by sedentary patients. We like our runners to be fitted for plantar fascial and achilles foot sleeves which help to take the strain and stress off the plantar fascia while running.  We also teach our patient about specific taping methods such as low dye taping that can be applied on the bottom of the foot to take the strain off the plantar fascia.  arch taping procedures.
5) Physical therapy
Physical Therapy is an effective modality for runners because investing this time can help to maintain and increase flexibility. We are big fans of ultrasound, cupping, dry needling, and iontophoresis.
6) Anti-inflammatory medication
Anti-inflammatory medications and cortisone injections can be used in the right situations to decrease inflammation and reduce soft tissue swelling. We typically will start with a short term course of oral NSAIDS and if the heel pain is severe enough will consider a series of cortisone injections to not exceed three in a given year.
7) EPAT (Shockwave Treatment)
The EPAT procedure is a state of the art non-invasive treatment for chronic plantar fasciosis and achilles tendonitis. The procedure is performed in the office setting without anesthesia. The procedure involves sending high energy sound waves into the heel to break up scar tissue and increase circulation so that the body heals itself. This is becoming the standard treatment for chronic heel pain and has a 85% resolution of heel pain 8-10 weeks out from the initial treatment. We have had a great number of runners suffering from chronic heel pain over the past few years do very well with this in office procedure.

CONCLUSION:
Runners presenting with plantar fascitis must be treated aggressively because they have immediate needs and long-range goals that are different than those seen in the average sedentary patient with heel pain. It is important to be aggressive and employ a variety of modalities and treatments when formulating a treatment plan for the athlete
The cornerstone of plantar fascitis treatment for the athlete is biomechanical. Podiatric practitioners possess the greatest skill set and knowledge available in medicine today to adequately address the pathomechanics of plantar fascia overload. The use of properly casted and designed custom foot orthoses should be the cornerstone of non-surgical treatment of subcalcaneal pain in the athlete.

38 comments:

  1. I believe there are many more pleasurable opportunities ahead for individuals that looked at your site

    Pain Relief Oil

    ReplyDelete
  2. We helps you to provide information about prescription drugs that are prescribed to treat various kinds of diseases. We deliver our services in the United States, USA. To place your order as overnight delivery, you can choose your products and place them at any point in time and get it delivered the next day at your doorstep.

    Here are some medicine provide with online prescription, they give information about medicine you want to buy. Visit their website for details

    Buy Methadone Online for Drug Addiction Treatment
    Buy Oxycodone Online for any kind of Pain
    Buy Adderall Online for ADHD and Insomnia
    Buy Soma Online for Muscle Spasm
    Buy Xanax Online for Anxiety Disorder
    Buy Phentermine Online for Weight Loss
    Buy Ambien Online for Sleep Disorder
    Buy Ativan Online for Anxiety Disorder or Epilepsy Treatment
    Buy Codeine Online for Severe Pain

    ReplyDelete

  3. Nice blog!! I am looking for the new one..
    If anyone want to know more about Epilepsy treatment or medication then you must read these blogs.

    All You Need To Know About Epilepsy

    What Are The Treatments For Epilepsy?

    What Are The Causes Of Epilepsy?

    Medications for Epilepsy
    Buy Clonazepam Online
    Buy Valium Online

    ReplyDelete

  4. Nice blog!! I am looking for the new one..
    If anyone want to know more about What Drugs are Prescribed for Anxiety? then you must read these blogs.
    Overview
    How to Get It?
    Are There Any Side Effects of Xanax?
    The withdrawal symptoms that can occur after the intake is stopped suddenly are:-
    Where to Buy Xanax?

    ReplyDelete
  5. Online Medz Pharmacy is a website that provides various types of medications. We help the persons who are suffering from some severe diseases like sleep disorder, ADHD, Weight loss, pain relief and anxiety disorder by providing them Xanax, Vicodin, Tramadol, and other drugs. We have all types of Generics and brands of medications with several strengths.

    Buy Alprazolam Online

    ReplyDelete
  6. Buy hydrocodone Online overnight Delivery in USA. We are the best and trusted online pharmacy in USA gives you the best and approved medicines by FDA.

    Buy hydrocodone Online
    Buy alprazolam Online
    Buy Xanax Online

    ReplyDelete
  7. Online Medz Pharmacy is a website that provides various types of medications. We help the persons who are suffering from some severe diseases like sleep disorder, ADHD, Weight loss, pain relief and anxiety disorder by providing them Xanax, Vicodin, Tramadol, and other drugs. We have all types of Generics and brands of medications with several strengths.


    Buy Adderall Online

    ReplyDelete
  8. ADHD refers to attention deficit hyperactivity disorder caused by differences in the brain. Patients with such conditions have trouble with focus. But some are also impulsive and hyperactive, especially in teens and kids.


    adhd medication

    ReplyDelete
  9. thanks!
    Purchasing drugs from a drug store can be tiring for many people who do not help on their side. We have given a few points that will clear the air why it is so beneficial to buy drugs from an online pharmacy like us.

    Buy Hydrocodone Online
    Buy Ambien Online
    Buy Codeine Online
    Buy Oxycontin Online

    ReplyDelete

  10. Rite Aid USA offer:
    * No Prescription Required (NO RX)
    * Buy Direct and Save Time with Cryptocurrency
    * Reshipment is offered if the package does not get to location or refunds
    * High-Quality Pharmacy Grade Medicines.
    * Best and Affordable prices.

    Buy Vicodin Online
    Buy Tramadol Online
    Buy Codeine Online

    ReplyDelete
  11. Online Medz Pharmacy is a website that provides various types of medications. We help the persons who are suffering from some severe diseases like sleep disorder, ADHD, Weight loss, pain relief and anxiety disorder by providing them Xanax, Vicodin, Tramadol, and other drugs. We have all types of Generics and brands of medications with several strengths.

    Buy Dilaudid Online


    Here are some interesting blog you should read them...

    Pain Relief Medication
    A Guide to Safe Use of Pain Medicine

    ReplyDelete
  12. We helps you to provide information about prescription drugs that are prescribed to treat various kinds of diseases. We deliver our services in the United States.
    Get your Medz online and save up to 50% at our selected Pharmacy.
    Buy Tramadol Online
    Buy Vicodin Online
    Buy Vicodin Online

    ReplyDelete
  13. Online Medz Pharmacy is a website that provides various types of medications. We help the persons who are suffering from some severe diseases like sleep disorder, ADHD, Weight loss, pain relief and anxiety disorder by providing them Xanax, Vicodin, Tramadol, and other drugs. We have all types of Generics and brands of medications with several strengths.

    Buy Lortab Online


    Here are some interesting blog you should read them...

    Pain Relief Medication
    A Guide to Safe Use of Pain Medicine

    ReplyDelete
  14. Online Medz Pharmacy is a website that provides various types of medications. We help the persons who are suffering from some severe diseases like sleep disorder, ADHD, Weight loss, pain relief and anxiety disorder by providing them Xanax, Vicodin, Tramadol, and other drugs. We have all types of Generics and brands of medications with several strengths.

    Buy Meridia Online

    Here are some interesting blog you should read them...

    Pain Relief Medication
    A Guide to Safe Use of Pain Medicine

    ReplyDelete
  15. What a nice post, I really very thankful to you for sharing such type of valuable content.
    All About Disorders, Symptoms And Treatment visit our informative blogs...
    Everything you need to know about Epilepsy
    FDA approves the use of Pfizer and BioNTech’s COVID-19 vaccine in the US
    How Addictive Is Cough Medicine?

    ReplyDelete
  16. Online Medz Pharmacy is a website that provides various types of medications. We help the persons who are suffering from some severe diseases like sleep disorder, ADHD, Weight loss, pain relief and anxiety disorder by providing them Xanax, Vicodin, Tramadol, and other drugs. We have all types of Generics and brands of medications with several strengths.

    Buy Adderall 20mg Online

    Here are some interesting blog you should read them...

    Pain Relief Medication
    A Guide to Safe Use of Pain Medicine

    ReplyDelete
  17. Our online pharmacy that provides information about diseases and their symptoms ranging from physical to psychological and what kind of medicines can cure them, based on their dosage, the type of disease it is being taken for, the kind of person taking the drug, etc. When you buy a drug from our website, we provide you with a prescription so that you can take the drug properly.
    Buy Adderall Online
    Buy Roxicodone Online
    Buy Hydrocodone Online
    Buy Xanax Online
    Buy Green Xanax Online

    ReplyDelete

  18. Online Medz Pharmacy is a website that provides various types of medications. We help the persons who are suffering from some severe diseases like sleep disorder, ADHD, Weight loss, pain relief and anxiety disorder by providing them Xanax, Vicodin, Tramadol, and other drugs. We have all types of Generics and brands of medications with several strengths.

    Buy Vicodin Online

    Here are some interesting blog you should read them.....

    Pain Relief Medication
    A Guide to Safe Use of Pain Medicine

    ReplyDelete
  19. Our online pharmacy that provides information about diseases and their symptoms ranging from physical to psychological and what kind of medicines can cure them, based on their dosage, the type of disease it is being taken for, the kind of person taking the drug, etc. When you buy a drug from our website, we provide you with a prescription so that you can take the drug properly.

    Buy Tramadol Online

    Buy Soma Online

    Buy Xanax Online

    buy Ambien Online

    Ambien for Sale

    Buy Adderall Online

    Buy Roxicodone Online

    Buy Hydrocodone Online

    Buy Xanax Online

    Buy Green Xanax Online

    ReplyDelete
  20. Ambien.org is the Best place to Buy Ambien Online and to also buy other medicines online with overnight delivery. Buy Ambien Online and order medicines online without prescription with overnight delivery in the USA at a discounted price from best online pharmacy and best online medical store.

    buy ambien online, buy ambien 10mg online, buy ambien 5mg online, ambien, ambien 10mg, ambien 5mg.

    Buy Ambien Online

    Buy xanax Online

    Buy Adderall Online

    Buy Tramadol Online




    ReplyDelete
  21. Online Medz Pharmacy is a website that provides various types of medications. We help the persons who are suffering from some severe diseases like sleep disorder, ADHD, Weight loss, pain relief and anxiety disorder by providing them Xanax, Vicodin, Tramadol, and other drugs. We have all types of Generics and brands of medications with several strengths.

    Buy Oxycodone Online

    Here are some interesting blog you should read them.....

    Pain Relief Medication
    A Guide to Safe Use of Pain Medicine

    ReplyDelete
  22. heelpaincharleston.blogspot.com/
    iamlivingwithanxiety.blogspot.com/

    ReplyDelete
  23. Best Pharmacy in USA......
    The main concentration of our company is to work according to the global standard of the business. We are working in this field for more than 10 years with thousands of satisfied customers so you can rely on our products.
    * Affordable rates.
    * On-time delivery.
    * Late-night delivery.
    * On-time delivery without delay on extra formality

    Buy Alprazolam online
    Best Place to Buy Dilaudid Online
    Tramadol for Sale
    Is it Legal to Buy Oxycodone Online

    ReplyDelete
  24. thanks!
    Buy Xanax Online -Xanax is a powerful benzodiazepine medication and a brand name for generic drug Alprazolam. Benzos are the group of addictive prescription medicines known for their calming effects in the central nervous system. Although this anti-anxiety medicine is a prescribed drug and also a controlled substance. Controlled substance means it is illegal to buy Xanax without a prescription from a medical doctor. However, people can Buy Xanax Online along with a free prescription.

    Buy Xanax Online
    Buy Adderall Online
    Buy Alprazolam Online

    ReplyDelete
  25. Buy Adderall20mg With 50% of on all products

    What is Adderall and how is it used?
    Adderall is a prescription medicine used to treat the symptoms of hyperactivity and for impulse control. Adderall may be used alone or with other medications.
    Adderall is a central nervous system stimulant.
    It is not known if Adderall is safe and effective in children younger than 3 years of age.
    Adderall is also effective for increasing daytime wakefulness in people with narcolepsy, although there is little related research available.

    Buy Adderall20mg Online

    Buy Xanax10mg Online

    Buy Tramadol Online

    ReplyDelete
  26. Get 10% off on use coupon- "SALE10"
    All type of medicines available online 24*7 in Xanax stores and fast home delivery so get it now.

    Order here-
    Get 10% off on use coupon- "SALE10"
    Buy Ambien Online
    Get 10% off on use coupon- "SALE10"
    Buy Dilaudid Online
    Get 10% off on use coupon- "SALE10"
    Buy Ativan Online
    Get 10% off on use coupon- "SALE10"
    Buy Adderall Online
    Get 10% off on use coupon- "SALE10"
    Buy Tramadol Online
    Get 10% off on use coupon- "SALE10"
    Buy Methadone Online
    Get 10% off on use coupon- "SALE10"
    Buy norco online
    Get 10% off on use coupon- "SALE10"
    Buy Percocet Online
    Get 10% off on use coupon- "SALE10"
    Buy Xanax Online

    ReplyDelete
  27. Order Anti-Anxiety, Detoxifying, Pain Relief, Sleeping & Weight Loss Pills online, without prescription at the best price in the United States - Medical Pharmacy USA.

    Buy Adderall Online
    Buy Alprazolam Online Overnight at low Price in USA and CANADA
    Buy Oxycontin Online l Order
    Oxycontin Online legally |
    Buy Oxycontin Online in USA
    and CANADA

    Buy Dilaudid online overnight
    Buy oxycodone online -without Prescription
    Know about Adderall
    Buy Oxycontin Online Overnight
    Buy Diazepam Online
    Medical Pharmacy USA - Order Anti-Anxiety, Detoxifying, Pain Relief, Sleeping & Weight Loss Pills Online

    Buy Adderall Online | Buy Adipex Online | Buy Alprazolam Online | Buy Ambien Online | Ativan generic | Buy Ativan Online | Buy Carisoprodol Online | Buy Codeine Online | Buy Diazepam Online | Buy Dilaudid Online | Buy Fioricet Online | Buy Hydrocodone Online | Buy Lorazepam Online | what is Lorcet | Buy Lorcet Online | Buy Lortab Online | Buy Meridia Online | Methadone for Sale | Buy Methadone Online | Buy Norco Online | Buy Opana ER Online | Buy Opana Online | Buy Oxycodone Online | Buy Oxycodone Online Legally | Buy Oxycontin Online | Buy Percocet Online | Percocet for Sale | Buy Ritalin Online | Buy Roxicodone Online | Buy Soma Online | Buy Suboxone Online | Subutex pill | Buy Subutex Online | Buy Tramadol Online | Buy Ultram Online | Buy Valium Online | Buy Vicodin Online | Buy Xanax Online | Xanax for Sale | Buy Xanax 1mg Online

    ReplyDelete
  28. thanks!
    Buy Norco Online – Norco is a prescription pain medication that combines acetaminophen and Hydrocodone. It is in a class of drugs called opioid (narcotic) analgesics and in a group of medicines called antitussive. In this combination of medicine, acetaminophen is a non-opioid medicine found in many popular medications like Tylenol.


    Buy Norco Online
    Buy Hydrocodone Online
    Buy Adderall Online
    Buy Alprazolam Online
    Buy Tramadol Online

    ReplyDelete
  29. thanks!
    Adderall 10mg identified in the form of a capsule called Adderall XR 10mg and which has the inscription of Adderall XR 10mg on it. Buy Adderall Online Without Prescription.
    Buy Adderall 10mg overnight, no rx required, Buy Adderall Online with various payment options at Adderall Store USA.

    Buy Adderall 10mg Online
    Buy Hydrocodone Online
    Buy Adderall Online
    Buy Alprazolam Online
    Buy Tramadol Online

    ReplyDelete