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Summer's the season for heel pain, but new treatment options can help
By Robert McCoppin | Daily Herald Staff

Retired Rosemont police Capt. Rick Drehobl uses exercises to prevent plantar fasciitis, but said a debated treatment involving sound waves helped reduce pain.

 

Mark Welsh | Staff Photographer

Stretching exercises help retired Rosemont police Capt. Rick Drehobl prevent pain caused by plantar fasciitis.

 

Mark Welsh | Staff Photographer

Stretching exercises help retired Rosemont police Capt. Rick Drehobl prevent pain caused by plantar fasciitis.

 

Mark Welsh | Staff Photographer

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Published: 8/16/2010 12:06 AM

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Stretch to prevent foot pain

A stretching routine can prevent pain from plantar fasciitis. Here's how:

• Cross your affected leg over your other leg.

• Using the hand on your affected side, take hold of your affected foot and pull your toes up toward your shin.

• Check for the appropriate stretch position by gently rubbing the thumb of your other hand over the arch of the affected foot. The plantar fascia should feel firm, like a guitar string.

• Hold the stretch for a count of 10, and repeat 10 times. Do this at least three times a day - more often is better. The most important times to stretch are before taking the first step in the morning and before standing after a period of prolonged sitting.

Source: American Orthopaedic Foot & Ankle Society.

When Rick Drehobl got up every morning and stood up to walk, a pain like nails shooting into his heels jolted him awake.

"It was absolutely brutal," he said. "I could barely walk in the morning. It was very, very painful."

Drehobl, 52, a retired Rosemont police officer who worked constantly on his feet, was suffering from one of the most common causes of heel pain: plantar fasciitis. It's known for being particularly painful when people first stand up each day.

A band of tissue that runs along the bottom of the foot, the plantar fascia connects the heel to the toes, supporting the arch and acting as a shock absorber. When it gets injured by repetitive impact, it swells up and hurts, and can range from a mild annoyance to a debilitating injury.

It's the same condition that has sidelined Chicago Bulls player Joakim Noah and White Sox outfielder Carlos Quentin. It's common in runners, dancers, people who stand while working or are overweight, pregnant women, and anyone who wears shoes with inadequate support or cushion.

It's most common between ages 40 and 60, and more common in women than men.

With summer in full swing, more wearing flimsy shoes like flip flops and an increase in people running outdoors brings a surge in cases of heel pain. Local doctors offer a variety of ways to treat it, and 90 percent of patients can be cured with conservative treatment.

When he was struck by the condition 10 years ago, Drehobl tried the rest and stretching exercises that are commonly the first line of treatment.

When that didn't work, he tried a new treatment, shock wave therapy, which uses sound waves to break up the tissue in an effort to cause microtears and stimulate bleeding and healing.

After one treatment on each foot, he felt like a new man.

"I tell you, it works," he said. "I definitely feel better."

Despite Drehobl's experience, the effectiveness of shock wave treatment is still under debate. Mayo Clinic says it "may cause bruises, swelling, pain, numbness or tingling, and has not been shown to be consistently effective."

But the man who used it on Drehobl is a firm believer and has a new study to support his view.

Of almost 200 patients Dr. Lowell Weil Jr. treated with sonic shock wave in 2001 and 2002, 75 returned surveys and 80 percent reported high satisfaction up to nine years later.

The survey was not scientific because people volunteered to participate, so those who were most satisfied may have been more likely to respond.

But Weil says he's seen shock wave treatment work time and again.

Weil is a team doctor for the White Sox and has treated a lot of the Chicago Bulls as well, though he couldn't talk about Quentin or Noah specifically. A board-certified foot surgeon, Weil is affiliated with several local hospitals and operates the Weil Foot & Ankle Institute in Des Plaines, Lake Forest and Libertyville.

One of his patients, Carol Rumatz, 51, a teacher from Crystal Lake, didn't have plantar fasciitis, but actually ruptured her plantar fascia.

She underwent shock wave therapy and was back water skiing six months later and remains free of pain.

Older high-energy treatments required sedation, while newer lower-energy treatments do not, but may require three treatments instead of one. Each treatment can cost $750 to $2,500 or more.

A 2002 Australian study in the Journal of the American Medical Society found significant reduction in pain for shock wave treatments, but no better than a placebo. Since then, insurance companies don't pay for the procedure, so it can be expensive for patients, but the cash upfront can be lucrative for doctors.

Dr. Steven Haddad, an orthopedic surgeon who specializes in foot and ankle surgery at the Illinois Bone & Joint Institute in Glenview, doesn't use the procedure and doesn't know any orthopedic surgeons who do it much.

He sometimes sees patients who've had shock wave treatment that didn't work, and he advocates physical therapy as the most successful treatment, but cautions that it can take up to nine months.

"I find it hard to understand how generating new scar tissue solves the problem," he said. "It doesn't make mechanical sense to me. I argue this often would have gone away on its own."

But some patients who've had heel pain for a year or two are desperate. As a last resort, Haddad offers surgery, but concedes it costs thousands of dollars, can cause complications, and has only a 50 or 60 percent success rate.

That's why it's so important, both Weil and Haddad agree, to follow conservative treatments first, like rest, icing sore soles and getting more supportive shoes.

Still, shock wave has its proponents among some podiatrists.

Weil considers the Australian study "horrible" because it didn't last enough to see if the treatment worked and was for patients who'd only had heel pain for a short time, who he said are not appropriate candidates for the treatment.

Dr. Ronald Hugar, a foot and ankle specialist who lives in St. Charles, uses shock wave therapy for the 5 to 10 percent of patients who don't respond to conservative treatments.

"I think it's a very effective treatment," he said. One advantage, he noted, is it's far less invasive and costly than surgery, which remains a follow-up option.

The diagnosis of the problem has evolved over time. In the past, bone spurs were often blamed for heel pain and surgically removed. Plantar fasciitis is still also known as heel spur syndrome, but it turns out many people with bone spurs have no heel pain, so that is not usually the cause.

The American Orthopedic Foot & Ankle Society in Rosemont offers no position either way on shock wave therapy. It does emphasize that stretching remains the best treatment, and offers a short list of stretches for plantar fasciitis online at aofas.org, under "patient education" and "ailments & conditions."