Dr. Roach: Foot pain? Don’t wait to visit a specialist!
Dear Dr. Roach: I am a 73-year-old male with continued pain in my right foot and ankle for the past five years. I try to stay active by golfing two days a week in season, and I walk 3 miles four times weekly around the neighborhood. The pain started about five years ago after a very active week of walking five days straight. My family doctor recommended I try some arch support inserts for my athletic and golf shoes, which I did try for one year. I stopped after that because they did not help.
He also referred me to a foot doctor, who I saw for two years. We tried a steroid shot and measured orthotics, but the pain continued. The foot doctor treated me for plantar fasciitis, and an X-ray indicated I may also have some arthritis. He recommended I massage the foot and plantar area, which does help. The third solution is surgery on the plantar fascia, or possibly on the joint with arthritis. I’m currently trying an over-the-counter gel for arthritis called Voltaren as a last resort before possible surgery. My questions are: What is your opinion of Voltaren and its success rate for my condition, and is there anything else I should consider before surgery?
Dear M.L.: Plantar fasciitis is a common cause of foot pain. Like you, many people will develop it after engaging in more activity than normal. Many runners get it. The pain is most often located on the bottom of the foot, just in front of the heel. The first step in the morning can be exquisitely tender. Treating plantar fasciitis aggressively when it first comes on, with some basic interventions such as stretching, heel pads or cups, limitation of activity and anti-inflammatories, usually is effective. My experience is that when the symptoms have gone on a very long time, it takes a very long time to effectively treat. Early referral to a specialist is indicated for symptoms that do not promptly resolve.
There are many other possible causes of heel pain. Since you have been dealing with this for five years, I will assume your foot doctor has done a thorough job of evaluation, but you might still consider a second opinion before committing to surgery. I am particularly concerned about this suspicion of arthritis. It may be that you have X-ray evidence of arthritis, but it’s unclear how much of the pain is due to arthritis.
When my own patients have been treated by an expert, I sometimes see the use of night splints or even casting for resistant cases. Ultrasound shockwave is used, but may not be effective. Platelet-rich plasma has been used, but it is not well-enough studied to comment on its effectiveness. Diclofenac gel (Voltaren) is not likely to solve the problem: It’s a good anti-inflammatory for issues that are superficial, but I’m afraid your problem is too deep and well-established for the gel to have much benefit. It cannot hurt to try, and you will know quickly how much benefit you will get.
I have never had a patient undergo surgery, but the literature does show that it is used as a “last resort” treatment for plantar fasciitis. Given how long you have been suffering with this condition, it seems reasonable to consider, but I strongly urge you to carefully research how much experience your surgeon has with this condition.
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