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Dynamic Chiropractic – September 12, 1990, Vol. 08, Issue 19

Heel and Arch Pain

By Keith M. Jeffers, DC, CCSP

One of the more common injuries that runners and aerobic enthusiasts suffer from is heel and arch pain. Another group of patients with a high incidence of heel and arch pain is the geriatric population.

So, whether your practice specializes in sports injuries or not, the following article may be of benefit to many of your patients.

Heel and arch pain can become a debilitating injury. I have treated many elderly patients who cannot be on their feet for more than 30 minute periods of time. As you can imagine, this type of injury can negatively affect a person's lifestyle. The majority of these patients are over the age of 60. Many, because of the severity of pain, or the restriction of activities, become very depressed.

I have also treated many younger patients who are involved in recreational sports and who suffer the same problem: intense heel and arch pain. Most of the time, these patients can still function in their jobs, but their recreational sports activities have been reduced, or in many cases, completely eliminated. These young athletes also can suffer from varying degrees of depression due to the lifestyle change.

Fortunately, in the cases of the recreational athletes, they can be treated by a sports injury specialist and the injury can usually be resolved. But, in the cases of the geriatric patients, their family physician may not have the expertise to successfully treat arch and heel pain. Often, if treatment is recommended, it generally consists of a series of cortisone injections or foot surgery to remove a "heel spur."

In most cases, heel and arch pain are caused by overpronation of the foot and foot subluxations. Overpronation is a rolling in of the foot. A dropped or fallen arch is now an overpronated foot. this overpronation of the foot eventually leads to an inflammation of the fascia, muscles, and ligaments on the bottom of the foot. This condition is diagnosed as plantar fasciitis. If the patient continues to exercise, the inflammation worsens and will lead to calcaneal bursitis.

Calcaneal bursitis usually is extremely painful on rising in the morning. Many patients state that they can barely hobble around for the first 30 minutes every morning. As the day progresses, the pain diminishes. This is due to the changes in the bursa sac. It becomes engorged with fluid while the patient is sleeping, then this enlarged sac is very painful to put pressure on upon rising. As the body is in a weight-bearing position during the day, the fluid is pushed out of the sac only to return again when the body is at rest in the evening. Eliminating the running or aerobic activity may lead to a reduced pain level, but in most cases, the injury will reoccur if the biomechanical problem of overpronation is not corrected.

Prolonged inflammation of the plantar fasciitis will lead to a calcaneal traction spur. This type of spur is best seen on a lateral foot radiograph. I usually place the plantar surface of the right and left foot together and take one bilateral radiograph.

Treatment of plantar fasciitis and heel spurs should start with conservative treatment before requiring radical treatment. Fortunately, in most cases, conservative treatment will resolve the problem. Treatment in our clinic starts with chiropractic treatment to correct foot, ankle, knee, and pelvic subluxations. The talus is the keystone of the foot and is frequently subluxated. A custom foot orthotic is then made for the patient in our office to correct their foot overpronation. We also recommend that our patients have a series of three to six deep tissue massages to reduce the plantar muscle spasm and assist in breaking up any adhesions. Ultrasound and electrical therapy are also prescribed.

This treatment program has been shown to be tremendously effective in the treatment of plantar fasciitis and heel pain. Very rarely do my patients require cortisone injections or surgical intervention for their heel and arch pain.

Doctors of chiropractic are the only physicians trained to administer this three-step program:

  1. Correction of subluxations of the lower extremities and pelvis.
  2. Fitting of custom foot orthotics.
  3. Physical therapy to the foot.

Hundreds of thousands of people are suffering with foot pain. Doctors of chiropractic should be the patient's first choice for treatment.

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