Is Plantar Fasciitis (Heel Pain) common? Dr. Wellens has the answer.

Plantar fasciitis, or heel pain, is probably one of the most common conditions that I see in my office. In fact, approximately 40%-60% of all patients that I see are due to some sort of heel pain. In Florida, I also find it more seasonal as Floridians wear a lot of flip-flops in the summer that provide absolutely no arch support and therefore are more likely to develop heel pain.

In the United States, approximately 2 million Americans seek medical attention annually due to plantar fasciitis. It is one of the most common musculoskeletal problems in the human body. 10% of people in the world will suffer from plantar fasciitis in their lifetime. Statistics are on our side as only about 5% of patients who have this condition will end up having to have surgery. There are multiple studies that show that just a combination of foot orthotics and night splints reduces pain by 50%.

Depending on the level of pain in the heel, Cortisone injections sometimes are necessary to help with healing process. Many studies have shown that functional orthotics prevent plantar fasciitis from coming back. A lot of my patients start experiencing heel pain 3 to 4 years after they have seen me and have received a pair of orthotics because they are starting to wear out and they need a new pair. Even if nonsurgical treatments do not work, there is a light at the end of the tunnel. There is a new procedure called Tenex that has success rate of close to 95%.

Central Florida Foot and Ankle Center
101 6th St Nw Winter Haven, Fl 33881
Phone: (863) 299-4551
www.FLFootandAnkle.com

Plantar Verrucae

A wart is a small growth in the skin that develops after contact with a wart-producing virus.  While a wart may develop anywhere on the foot, it most commonly occurs on the bottom of the foot.  When this happens, it is known as a plantar wart.  Plantar warts are most commonly seen in children and the elderly, but may effect anyone of any age. 

Two patterns of plantar wart growth are commonly seen.  Solitary warts may be seen as isolated warts on the bottom of the foot.  This type may grow in size, and can eventually lead to other warts along the bottom of the foot, commonly referred to as “satellite” warts.  Mosaic warts are another growth pattern, which is a large cluster of smaller warts.  These are often much more painful, and are more difficult to treat than single, solitary warts. 

Plantar warts, whether they are solitary or mosaic, are caused by direct contact with a particular strain of human paplloma virus (HPV).  This virus can cause warts on other body parts, but plantar warts will stay on the foot or hands.  They do not spread to other body parts. 

Plantar warts may appear as an area of thickened skin on the bottom foot.  They can be quite painful, particularly when squeezed from side to side.  Small black dots may be seen within the wart.  These dots are bits of dried blood from the capillaries of the skin.  The wart “steals” blood supply from the deeper skin, and the capillaries will grow into the skin. 

A podiatrist may diagnose a plantar wart through physical examination, as well as taking an account of the symptoms.

There is a large variety of treatment for plantar warts.  Topical treatments may include strong acids, laser therapy, cryotherapy (freezing the wart), or other forms of cautery.  For very large and difficult warts, surgical excision may be required. 

Some advocate oral therapy to help in the treatment of warts, including vitamin supplementation.  Some anti-viral medications have also been used. 

Many home remedies have been discussed, including covering the wart with duct tape.  These methods may work in some cases, however, the natural history for a plantar wart is to eventually resolve.  So, it is unclear whether it is the duct tape that is working, or simply giving the body time to clear up the wart on its own. 

Occasionally, a wart will be very resistant to treatment.  If a wart has an atypical treatment, or is unresponsive to various treatments, a biopsy may be warranted to rule out other causes of skin growth. 

Plantar warts should be managed by a podiatrist, as home treatment can result in injury.  Particularly in diabetic patients, home use of strong acids or other methods of removal can lead to dangerous complications.  

Central Florida Foot and Ankle Center 
101 6th St Nw 
Winter Haven, Fl 33881 
Phone: (863) 299-4551 
www.FLFootandAnkle.com

Post-Traumatic Arthritis

The term "arthritis" refers to inflammation of a joint.  There are a number of causes of this inflammation, but most commonly it is due to a degeneration of cartilage within the joint, known as osteoarthritis.  The diagnosis of post-traumatic arthritis is used when there is a history of acute trauma or damage to the joint.  The injury may have occurred during sports, a fall, a motor vehicle accident, or any other source of trauma.  In the foot and ankle, this is a common cause of chronic pain.

Post-traumatic arthritis of the ankle joint is extremely common following a bad sprain or fracture of the bones of the joint.  In fact, most studies indicate that upwards of 50% of ankle arthritis is due to a history of injury, and is not a primary arthritic condition.  Any joint of the foot or ankle may be affected if there is a history of injury.  The symptoms include pain and swelling in a joint, fluid accumulation within the joint, and difficulty with activities such as sports, exercise, walking up stairs, and other activities that put added stress on the affected joint. 

Following an injury to the foot or ankle, the joints may become misaligned through faulty healing, or may have damage to the cartilage from the injury itself.  This misalignment of a joint can cause major pain and disability, which will worsen over time. 

A diagnosis of post-traumatic arthritis is often made clinically.  There is generally a history of trauma to the joint, whether it is remembered or not.  Often the trauma can be subtle, such as repetitive ankle sprains.  X-rays may be used by the treating physician to confirm the diagnosis, and to evaluate the symptomatic area. 

Treatment of post-traumatic arthritis often focuses on removing the symptoms of pain and preventing further deformity.  Orthotics and other forms of bracing are often helpful for foot and ankle post-traumatic arthritis.  Icing, rest, and the use of oral anti-inflammatory medications may be helpful as well.  Injections into the joint with corticosteroids may also provide some relief.

Occasionally surgery may be warranted in severe cases.  Depending on which joint of the foot or ankle is affected, various procedures may be beneficial to the patient.  This may include procedures such as fusing joints so that they no longer move, rearranging tendons and ligaments to provide more support to the joint, and possibly cutting bones and moving them to realign the joint. 

Central Florida Foot and Ankle Center 
101 6th St Nw 
 Winter Haven, Fl 33881 
Phone: (863) 299-4551 
www.FLFootandAnkle.com