Glenn Pfeffer of San Francisco knows all about heel pain--and not just because he's an orthopedic surgeon and president-elect of the American Orthopaedic Foot & Ankle Society. Pfeffer, 49, himself suffered from the condition, called plantar fasciitis, for nine long months, until his pain went away for reasons he still can't pinpoint.
He's one of the lucky ones. More than 3 million Americans seek treatment for this malady each year; perhaps 7 million more deal with the discomfort on their own. Foot specialists say they are seeing a surge in cases as baby boomers jog into middle age. Some patients develop small bony growths, called heel spurs. But the pain is actually thought to be caused by damage to and inflammation of the plantar fascia, a gristle-like connector that runs between the heel and toes and helps support the arch.
Runners and women in their 40s and 50s (who may be balancing a bit more weight above those high heels) are especially vulnerable. Yet anyone who spends a lot of time on his or her feet, walks or runs on hard surfaces, has put on extra pounds, or has tight achilles tendons might get up one morning to feel an excruciating jab in their heel.
The worst chronic cases have been treated with surgery to snip part of the fascia to loosen it. A new treatment--available in the U.S. for about two years--uses shock (or sound) waves to break up scar tissue in hopes of encouraging increased bloodflow and, ultimately, repair. But this therapy just came under attack after an Australian study, published in the Journal of the American Medical Assn. (JAMA), said it offered no benefit over a placebo.
Two companies have won Food & Drug Administration approval for their shock-wave treatment machines: HealthTronics Surgical Services (maker of the OssaTron) and Dornier MedTech (which makes the Epos Ultra). Both say the Australian study is flawed because it did not focus on the chronic sufferers their treatment is designed to help, that the shock-wave energy levels were set too low, and that the control group received shock-wave treatment too, just at a lower level.
For most sufferers, simple, inexpensive home remedies may be enough. Stretching exercises to loosen the Achilles tendon--and so put less tension on the fascia--is a good start. You could also try inserting a pair of soft, over-the-counter heel cups in both shoes; taking anti-inflammatory drugs naproxen or ibuprofen; cutting back on pounding exercises; and applying cold compresses to the inflamed foot.
Recalcitrant cases can linger for months, even years. About 1% of those with this problem never get better, Dr. Pfeffer says, and 5% require surgery. The doctor had tried all the home methods--even wearing a removable cast on his foot for three weeks--and was on the verge of going in for painful cortisone shots in his heel. Then he took a quiet vacation and returned to realize his pain had vanished.
Kristine Clarkson is still waiting for that moment. The 44-year-old Eureka (Calif.) woman twisted her left ankle on Valentine's Day, 1999. She thought she had a simple sprain. Eight months later, both heels began hurting whenever she walked a block or stood an hour. Three years later, after trying stretching, heel cups, anti-inflammatory drugs, sleeping in a night splint, physical therapy, cortisone shots, and surgery to remove a heel spur and clip part of the taut fascia in her left foot, Clarkson is no better. Her final hope, she says, is the shock-wave treatment.
In the end, it will be the patients who determine whether shock waves can substitute for a last-resort surgery that can mean weeks in a cast and residual pain for up to a year. In Clarkson's case, her insurance recently agreed to cover the treatment, which typically runs $3,000 to $5,000. (About half of insurers do.) So she's going to give it a try. The alternative could be a lifetime of pain.
By Carol Marie Cropper
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