Plantar Fasciitis or Heel Spur Syndrome

 

We graduated from Podiatry School on April 30.  There really wasn’t much to do until the start of our residency on July 1.  Sure I ran for almost an hour daily and went to the gym, but the rest of the time was spent lounging around the pool and shooting the breeze with classmates. We promised to stay in touch with each other, talk often and attend the same seminars for the next forty years.

On July 1, the traditional day all residencies start, I showed up at 6.30 am for my first rotation; two months on the in-patient internal medicine service.  This service took care of the really sick patients, patients in the ICU, patients in kidney failure, acute heart patients, trauma patients such as motor vehicle accidents, victims of Philadelphia inner-city knife and gun clubs, and of course drug overdoses.

The schedule was simple.  Be at the hospital when you needed to be there to get the appropriate laboratory tests ordered and the results by 8.00 am when rounds with the attending started.  As the entourage moved from room to room, you presented your patient to the attending physicians and the rest of the group of maybe ten or twelve interns, residents and fellows.  After the first day, anyone was a target for what is known in medical education as “pimp” questions; those so complicated there may not be a correct answer.  The goal was to get through about ¾ of the hospitalized patients by noon.  If you were lucky you could grab a pretzel, go back and see your patients again, then reconvene with the group at 12.30 pm, see the remaining patients not visited in the morning, and then revisit the sickest patients to check on improvement or deterioration.  When rounds on the in-patients were completed, it was time to perform histories and physicals on the newly admitted patients.  Nowhere in the schedule were the words “chair” or “sit” to be found.

I woke July 4, got out of bed, and headed to the bathroom.  I swear on my Mother’s grave, as they’re prone to say in Philadelphia, regardless if your Mother is dead or not that there were sparklers going off in each heel.  I literally dropped to my knees completely unaware at the moment what was wrong.  I got up, hobbled to the bathroom, showered in pain, got dressed, and limped to the car for the drive into downtown Philadelphia from Cherry Hill, NJ.  My heels felt a lot better.  I parked the car, and when I stood up, the pain was back and just as intense.  Someone was driving nails into my heels.  The thought that I would not be sitting for the next twelve hours or so caused me to break out in a sweat.  I had figured out on the drive-in I was suffering from plantar fasciitis, an inflammation of the fibrous band of tissue that runs from the heel bone almost to the toes and helps support the arch of the foot.  I had seen patients as a student who suffered from the problem on one heel, but never two.  Some people call the problem heel spur, syndrome, but the spur doesn’t cause the pain and about 1/3 of the normal population has spurs with never a problem.

I fit one of the clinical pictures for patients developing plantar fasciitis to a T. I had gone from relative inactivity for two months to prolonged periods of standing.  Some folks, however have no such history and just suddenly develop pain in the heel when they stand up or get up in the morning to go to the bathroom.  Same happens in the evening.  They’re watching TV and get up to go to the bathroom or grab something from the refrigerator. Extreme pain that gets a little better with walking, but standing in one spot is miserable.

I suffered in silence for a week or so, then a chief resident asked what was wrong.  I told him and he replied that most of the residents had suffered from the problem when they were new.  That was the reason most of the residents in the hospital wore wooden clogs.  I stopped at the clog store on the way home to buy a pair.  It literally was instant relief.  It goes against conventional logic for clogs to work.  You’d think something soft to cushion the heel.  No, something rigid to support the arch and the plantar fascia distributing the tension along the whole plantar fascia is the key.  I literally wore clogs from that day until I retired.

Simply sliding into a pair of clogs doesn’t work for everyone.  Some folks respond to orthotics, others improve with a cortisone injection or two. Some patients need pulsed sound waves delivered to the foot.  The sound wave machine used for this procedure is a cousin of the one used to break up kidney stones.  A few patients go on to a partial endoscopic plantar fasciotomy.  This is a procedure performed through two tiny (about ½ cm) incisions.  A television camera is inserted through one of the incisions and a knife through the other.  The portion of the fascia under tension is released and the pain alleviated.  The spur, if present is usually left intact.  Most people return to full-time work pain-free in a couple weeks.

There is no need to suffer from blinding heel pain when a trip to the podiatrist can relieve this painful condition.