I shouldn’t be telling you this, but….

July 26th, 2012

Guess what your favorite podiatrist woke up to this morning: Heel pain. Heel pain and plantar fasciitis account for about 15-20% of the patients that come into good old Barking Dogs Foot and Ankle Care in Plymouth Meeeting, PA. I speak ad nauseum about stretching and icing and beg people to follow my directions. Being that my patients are the BEST (eh hm), they always follow what their doctor says, but what about when the doctor doesn’t take his own advice.

It happened to me. I’ve been training for a race, and as I’ve discussed before, I am not the skinny little kid I was back in these days.

Sean Pelkey, Marc Cianfrani, Kevin Myles, Thomas Sabol

Sean Pelkey, Marc Cianfrani, Kevin Myles, Thomas Sabol

So the training is different and the mileage is way different. (100 miles per week vs. 30 miles per week). Usually I am in a rush, stretching gets the bypass with the feeling that I’ll just start slowly and stretch out as I go and the result is this.

Here are my symptoms, doc:

Whenever I wake up and step down on the floor, directly under my heel I feel serious pain. It’s hard to describe, it BURNS, it is STABBING and it radiates up my leg and into my arch. If I can keep going, it eventually warms up and I can get through the day. (SMART WORD ALERT: POST STATIC DYSKENESIA)  This pain without treatment continues to worsen. Until I go see my local foot and ankle doctor.  (For me this only takes a glimpse in the mirror and a aggressive talking to.)

It is likely that you are suffering from a condition called Plantar Fasciitis. This is a sports injury that can occur from overuse/training injuries. It is very common and it can happen to any foot type and person type. I have treated elite runners to the hard working person on their feet all day.  Usually, when having a thorough history of the problem and a physical examination by your podiatric specialist, a determination of your problem and treatment plan can be started.

Plantar fasciitis is an inflammatory process involving a band of tissue that runs from the heel bone to the ball of foot and toes on the bottom of your foot. Due to repetitive injury and overuse, the area where this band inserts can get inflamed and sometimes tear.  The injury itself can hurt but also due to inflammation in the area, a nerve (BAXTER’s NERVE) can get entrapped. THIS IS WHY THIS PAIN IS LIKE NOTHING YOU”VE EVER EXPERIENCED. There is something about nerve pain, no disrespect to the other pains in our life, but nerve pain is exquisitie in its ability to stop a moving locomotive aka YOU.  The plantar fascia’s job is to support the arch of the foot an function in stabilizing the foot in the gait (walking) cycle. The reason why the pain will go away is because you are warming up the area and it help reduce the inflammation. But as soon as you sit down: welcome back heel pain.


First and foremost you should search out a medical evaluation to help diagnose the problem. There are others things that this could also be; so a good, handsome young foot doctor, particularly one located in Plymouth Meeting and a former runner, would be the best.

Depending on the findings, a treatment plan will be established. Don’t fear that when you go to the podiatrist, that you are locked in for a needle and a follow up appointment in two weeks. At Barking Dogs Foot and Ankle Care, I believe in the body’s intrinsic ability to heal itself. I like to establish a treatment plant that focuses on supporting the plantar fascia, relieving the stress through a stretching program and possibly looking into a therapeutic intervention to get you back to action ASAP. An xray is helpful to diagnose this problem further.

Alot of patients come into the office and say “I have a heel spur, my friend told me that.” And it is likely that you may have a heel spur, but in my experience, if I took x-rays of ten patients, 6 would have a spur on their heel bone (calcaneus), and only 1 of those patients would complain about it.  This is a biomechanical problem, so in order to treat this we need to treat the entire body in the walking cycle. That’s why stretching, support and control of inflammation can be so effective.

Surgery is never the first option and if that is what is suggested to you, kindly excuse yourself from the room, settle up and exit the office. The body with the right treatment plan can heel (get it) itself!

This is a topic that will only grow, next time we will talk about the future of treatments in heel pain with a focus on physical therapy. treatment.

But as always; I leave you with a question: What do you think is the most common misconception about foot doctors?

4 thoughts on “I shouldn’t be telling you this, but….

  1. KECorcoran

    most common misconception: either (a) they only take care of toes/feet or (b) the ones in Plymouth Meeting are ‘good, handsome and young’ 😉 P.S. Good read!

  2. Chris Cummins

    Dr. Pagano – Not unlike yourself, I was once an “elite” runner routinely putting 100 mile weeks under my belt along with bi weeekly track and hill workouts with legends like Mike Fox and Seneca Lassiter. After 4 years of High School and 3 years of intense Division 1 college training, I finally realized that I wasn’t a superhero and began to suffer my first injury… Plantar Fasciitis. At first in just one heel but soon after both were agonizing. Fighting for spots on relay teams and shooting for PR’s doesn’t allow for “resting” a nagging injury in the middle of your Jr. year outdoor season. I took the advice of a guy that once told me the sound that a unicorn makes and actually started ice bathing my feet, regularly stretching, messaging the inflamed areas, playing endless seasons of NHL 2000, and I was able to make it through the rest of that season before taking a few weeks off in the summer to recover. The important lesson here is to listen to your foot doctor or the guy that will be your foot doctor one day.


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