Dear Dr. Roach: I’m a 73 year old man and have been having pain in my right leg and ankle for the past 5 years. I try to stay active by playing golf two days a week during the season. I also walk around the neighborhood four times a week for three miles. The pain started about 5 years ago, after a very active week of walking straight for 5 days. My doctor advised me to try the arch support inserts for athletic and golf shoes that I have tried for a year. I quit afterwards because they didn’t help me.
He also introduced me to a podiatrist who had seen me for two years. I tried steroid shots and measured the brace, but the pain continued. The foot doctor treated me for plantar fasciitis, and x-rays showed that I might have some arthritis. He recommended that I massage the area of the feet and soles, which helps. The third solution is surgery on the plantar fascia, or perhaps a joint with arthritis. I’m currently trying a commercial gel for arthritis called Voltaren as a last resort before possible surgery. My question is: What is your opinion on Voltaren and its success rate for my condition, and is there anything else I should consider before surgery?
Dear ML: Plantar fasciitis is a common cause of foot pain. Many people, like you, develop it after engaging in more activities than usual. Many runners get it. The pain is most often on the sole of the foot, just in front of the heel. The first step in the morning can be exquisitely softened. Aggressive treatment of plantar fasciitis when it first develops and basic interventions such as stretching, heel pads or cups, activity restriction, and anti-inflammatory drugs are usually effective. In my experience, if the symptoms last for a very long time, it will take a very long time to be effectively treated. Early referral to a specialist is required for symptoms that do not resolve immediately.
There are many other possible causes for heel pain. You’ve been working on this for five years, so I think your foot doctor has done a thorough evaluation, but you can also consider a second opinion before performing surgery. I am particularly worried about this suspicion of arthritis. There may be evidence of arthritis on x-rays, but the extent of the pain caused by arthritis is unknown.
When my own patients are treated by specialists, I sometimes see even casting for night splint use or resistance cases. I am using an ultrasonic shock wave, but it may not be effective. Platelet-rich plasma has been used, but has not been sufficiently studied to comment on its effectiveness. Diclofenac gel (Voltaren) is unlikely to solve the problem: it’s a good anti-inflammatory agent for superficial problems, but your problem is too deep and established, and the gel has many benefits I don’t think you can get it. There is no harm in trying it. It’s easy to see how much profit you can make.
I have never had surgery on my patient, but the literature shows that it is used as a “last resort” treatment for plantar fasciitis. Given how much you are suffering from this condition, it is reasonable to consider, but it is highly recommended to carefully study how much experience your surgeon has in this condition. ..
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