Dr. Wellens and Dr. Ortiz Discuss Heel Pain

Dr. Wellens DiscussES Heel Pain

Rem Jackson: Hello everyone. This is Rem Jackson and welcome to today's call. I'm really excited that today I have returning to my call Dr. Tatiana Wellens and Dr. Narmo Ortiz of Central Florida Foot & Ankle Center, LLC. They are podiatrists and they practice in a variety of locations in the state of Florida, which I will tell you those locations later, and they have agreed to come back to the call.

We had a previous call with them about the problems that have with their feet and their ankles and the response was so great that we just wanted to bring them back and talk about a very specific issue today and that is heel pain.

Heel pain is reaching epidemic proportions in our country. There are reasons for that and there's some really, really fascinating information about heel pain and how it affects us and what we can do about it.

And so Dr. Wellens and Dr. Ortiz have agreed to come back on the call today and share with us about this particular issue.

So first off all, Dr. Wellens, Dr. Ortiz, I want to thank you so much for coming back today on the call.

Dr. Wellens: Our pleasure.

Dr. Ortiz: Our pleasure.

Rem Jackson: Okay, well let's just jump right into it. Dr. Wellens, I do want to ask you, before we really hit the topic of heel pain if you wouldn't mind just giving the listeners today really a brief definition of what a podiatrist is.

Dr. Wellens: A podiatrist is a physician who has a license to practice medicine and it's a type of medicine that deals with foot and ankle problems. Usually most podiatrists are board certified by either the American College of Foot and Ankle Surgeons or there are several other specialty boards that certify a majority of the podiatrists that hold the licensure.

In the state of Florida a podiatrist basically deals with foot, ankle and knee problems, basically any type of musculoskeletal problems below the knee.

Rem Jackson: That's great. So I guess in other words, a great way to sum that up is you are the experts on the feet and the ankles. Have I got that right?

Dr. Wellens: Absolutely. We are.

Rem Jackson: Dr. Ortiz, most of the people listening to this call today or those that are going to be listening to it later are interested in this topic because either are personally experiencing heel pain or they're responsible for the health of a loved one who has concerns and problems with pain, really specific kinds of pain in their heels.

So would you do me a favor and just explain really what are the most frequent symptoms that your patients are experiencing whenever they come in to see you and they're complaining about having heel pain.

Dr. Ortiz: The most common heel pain symptoms that we encounter in our practice are mostly related to heel pain that occurs in the plantar aspect or the bottom of their heel. It usually refers to pain centrally located just underneath the heel bone or it can refer into the arch of the foot as well.

Now we also see a lot of common heel pain that could be in the posterior or the backside of the heel that can be caused also by a spurring of the heel bone in the area where the Achilles tendon inserts causing inflammation and pain in the area as well.

Also I children we can see heel pain also occur due to a condition that is called calcaneal apophysitis, which is an inflammation or a sliding of the growth plate that occurs in that part of the heel where they suffer from pain and discomfort, especially when they're active children playing sports.

But the most common heel pain condition that we see is the one that caused by plantar fasciitis, which is an inflammation of the plantar ligament. That's a ligament that supports the arch of the foot and it starts from the heel bone and it goes all the way to the ball of your foot with some fibers connecting into the tendons that go into the toes.

Rem Jackson: Thank you for that explanation. That is very thorough. Dr. Wellens, now I've heard that sometimes people discover that they have heel pain quite dramatically when they wake up in the morning and set their foot down on the floor. Am I right about that? And can you kind of give me a sense for what that is and what causes that?

Dr. Wellens: Yes. For one, there is a very characteristic type of pain that people have when they have plantar fasciitis. The medical term for it is full static dyskinesia but you are exactly right.

Basically what it means is that when you wake up in the morning and take the first step it hurts the most but you can kind of walk it through and it hurts less.

There's a very easy explanation for that. Basically when we sleep the structure called plantar fascia, which is a ligament that runs on the bottom of the foot and supports our arch shortens. So when you stand up after it shortens, over a period of the night or like if you're driving a car for 30 minutes and then you get out, what happens is it pulls the hardest on the heel bone and that's what causes that severe pain initially.

As we start walking, that pain obviously goes away slightly or sometimes a lot because the ligament stretches as we walk and we put pressure on it. Therefore, Rem, what we recommend is before people stand up and experience all this pain, they can stretch, and there are very specific stretching exercises for the condition that can alleviate a lot of that initial pain with the first step.

Rem Jackson: That is such an interesting way for the pain to occur. And actually, I know folks that have had exactly that experience.

Now, we had mentioned before, Dr. Ortiz, you had been talking about children. You mentioned obviously adults, but how common is heel pain? I've heard numbers as high as one in four Americans will experience heel pain at some point in their life. Is that correct?

Dr. Ortiz: Yes, you are correct. Dr. Wellens mentioned before about two million people suffer from heel pain every year and half of them may go untreated if they don't seek the appropriate referrals or treatment course. So podiatrists in general see about a million patients a year in total with this condition.

So it's a very common condition, especially in the -- as you mentioned before, we have people that are more active basically right now so they're suffering more from the condition and also from people that wear the inappropriate shoe gear or shoe gear that does not support the arch of the foot.

Rem Jackson: I see. So our active lifestyles are actually in some cases conspiring against us to cause heel pain. And that's probably because we're not preparing our feet before sporting activities and stretching, Dr. Wellens, is that true or is it something you just can't do anything about. Were you born with the condition?

Dr. Wellens: I think that definitely genetically, Rem, we're pretty exposed to what foot type we inherit but obviously genetics is not everything and we do know that excessive pronation, which is basically a normal flexible motion and flattening of the arch is what prompts us to have plantar fasciitis.

But besides the stretching exercises before we jog or exercise, that could definitely help the condition, things like proper shoe gear, proper exercise show gear and also orthotics, which are special orthopedic arch supports that go in the running shoe or exercise shoe, can definitely help the condition and prevent it from getting worse.

Rem Jackson: I see, so good -- it may be something you're predisposed to but if you get the right kind of help and you also take good -- when they say you should stretch before you run, they actually mean it, I guess, in other words. So very important and good information.

Now I heard a number that said that as many as 95% of the people that experience heel pain are able to be cured of this condition without having to have surgery or other what we would call non-conservative treatments.

Dr. Ortiz, is that number right?

Dr. Ortiz: Yes, that number is right. As Dr. Wellens mentioned, we have a success rate from 85% to 95% of resolution of symptoms without the need of surgical options. There are many conservative treatment options that are available in our armamentarium, if you want to call it that way, where we can treat the patient very thoroughly and consistently and obtain consistent positive results.

So we are very proud of the methodologies that we use in our practice because we achieve such a high success rate of resolution. But definitely surgical is the last resort and when it's needed, of course it is used. But most of patients get better with conservative treatment.

Rem Jackson: Wow. So in other words, if you have this problem, you can cure this problem and the quicker you get in, the better it will be for you and so why anyone would suffer for this is unclear in my mind certainly.

Now, Dr. Wellens, say I have heel pain, I come in, you diagnosed that I have heel pain, we've figured that out, what are the kind of treatments that you offer for heel pain? What do you typically try to do?

Dr. Wellens: Stretching exercises are definitely a really good way to start. Also usually we would prescribe an anti-inflammatory medication for the patient to take by mouth that is similar to either ibuprofen or Motrin but it's a prescription strength anti-inflammatory, unless there is some sort of medical contraindication with the prescription.

Also we would refer the patient to physical therapy, which would consist of iontophoresis, stretching, electrical stimulation and we would also dispense a device called a night splint, which is a boot that puts your ankle at a 90 degrees and what it does is it stretches that plantar fascia so it does not shorten or contract as you sleep.

We would also typically ask the patient not to go barefoot and dispense some sort of orthopedic arch support to go in their shoes to prevent that pronation force that I was talking about earlier.

And that would probably, what happens on the first visit.

Rem Jackson: I see. That's fascinating and there's just so many things; you seem to have so many tools and procedures at your disposal that you can use to just help people get better and not suffer from this very, very common and painful condition.

Dr. Ortiz, what can our listeners do that are on the call today, what can I do today if I don't have heel pain to try to prevent getting it in the future?

Dr. Ortiz: The most important thing, if you are a person that is actively involved in an exercise program, of course most people like to do their stretching especially before and at the end of an exercise session, specifically stretching exercises of the plantar ligament or plantar fascia are very important as well as the Achilles' tendon has some of the fibers of that tendon also interconnect with the plantar fascia in the junction where they meet at the posterior or inferior part of the heel bone.

It is very important also that shoe gear is most important, the correct shoe gear, to whatever athletic activity you're involved in and make sure that that shoe has a good arch support system in place so that it will keep that ligament in a stretched and relaxed position and avoid the pronation, the formula, that Dr. Wellens was talking about.

Those things are usually the most important factors in trying to avoid and prevent future heel pain.

Rem Jackson: Thank you so much for that. That is very, very helpful and something that I'm going to incorporate into my daily routine for sure.

Really I think there's only one last question and that is Dr. Wellens, I think the big question on every one of the listeners' minds today is how can they get in touch with you at your office?

Dr. Wellens: Basically, they have several options. They can either call the office and obviously, Rem, if you don't mind providing that information to the listeners, but we have several telephone numbers they can contact us with and we have operators standing by.

Also if they don't like using phones, they can actually request an appointment online and that might be an easier way where they can tell us what is the best time to contact them and we would be more than happy to do that as well.

So those are the most efficient ways of getting in touch with the office.

Rem Jackson: Yes, I've got that information here so let me make sure everybody has that. The main number that they can call, and actually I promised at the beginning I would mention the locations where you have your offices and there's quite a few.

You have offices in Winterhaven, in Davenport, Lakeland, Cape Coral and Lehigh Acres. And for all of those except the Cape Coral office, the main number that they can call is area code 863-299-4551. And for Cape Coral the number is 239-573-1505. And I will give those to everybody again in just a moment.

They can also find you on the Internet at www.flfootandankle.com and now the other thing I wanted to mention is Dr. Wellens you have a book that you have produced about concerns that people have with their feet and their ankles. And correct me if I'm wrong but as I understand this you're willing to give that to anyone in the community that requests it, absolutely free of charge. Am I right about that?

Dr. Wellens: Absolutely.

Rem Jackson: That's tremendous.

Dr. Wellens: We're so adamant at Central Florida Foot and Ankle Center, LLC, we're adamant to provide education to the general public so they don't have to live with pain on a day to day basis and they don't have to stop exercising and they can continue enjoying their golf game, their tennis game. They don't have to compromise all those, Rem.

They can come in, we can help them; we can get them back on their feet to where they can enjoy daily activities and not suffer with foot pain.

Rem Jackson: That's just so impressive and I really commend you for doing something like that for the community.

So folks if you'd like to get the book that they have made available, you can call a special number. This is a toll free number. It's 866-415-5442 and just leave your contact information there and the folks at Central Florida Foot and Ankle Center, LLC will make sure that that is mailed out to you in the mail and you get your own copy.

Also, you can go to their website, which I mentioned before, www.flfootandankle.com and there's actually an image of the book there. You click on that, there's a little form, you fill it out and they all make sure that you get that as well.

And I believe too that you'll send some more information that's just good, quality, educational information to help people stay healthy.

And so I promised before I would give you those phone numbers again. The main number is 863-299-4551 and the Cape Coral office number is 239-573-1505.

Dr. Wellens, Dr. Ortiz, I want to thank you so much for taking the time out of your schedule today. I know you've got to get back to your patients but I really enjoyed this and if there's any way I might convince you to come back on another call at another time, I would just love to do that.

So first of all, thanks so much for joining us.

Dr. Wellens: Our pleasure. Thank you so much, Rem, for having us.

Dr. Ortiz: Thank you so much for having us.

Rem Jackson: I'm just delighted. And folks until next time, this is Rem Jackson and have a great day.