The "Heel That Pain" Story
Hi, I’m Art Smuckler, C. Ped, OST, and inventor of the Fascia Bar, an invention clinically proven and very well received by everyone from clinical patients to world class NBA athletes. In any practice, it is in my opinion that it is more flattering to receive patient referrals, than any other type. This, to me, is a great indication that what were doing for the patients is working. In no area is this more obvious to our office, than with those patients that have been treated for heel pain. Their approval is my reward. Just see the hundreds of testimonials from people just like you.
For years, people have sought their doctor�s medical attention, gone to physical therapists, had shots of questionable steroidal drugs, gone through surgical procedures, and worn countless types of over the counter pads, cushions and gels. Patients have tried nearly everything to try and deal with a problem called Plantar Fasciitis.
As a young pedorthic practitioner in the late 1960’s, my findings were as follows. Anyone with pain at the bottom of the heel received a diagnosis of suspected heel spurs. A heel spur is a small hook-like calcification, jutting off the bass of the heel bone, or calcanius. It is intriguing how many people were diagnosed with this anomaly, and how many health care professionals wrote prescriptions asking me to treat their patients using thick foam heel pads with donut shaped cutouts. I have been dealing with patients, who by the time they�d gotten to me would have done anything to get rid of their annoying, life altering heel pain. All the patients wanted to know was, �will this work?�
All we could expect back in the 1960’s was a small reduction in pain when treated conservatively. In too many cases, relief of any significant degree was not found. You can imagine the frustration of the care giver in not being able to help their patient with this painful modality, not to say anything of the poor patient who would try anything and everything for some kind of pain relief.
As time went by, and more podiatrists became more active as treatment-givers for this modality, it became clear that heel pain, plantar fasciitis and heel spurs were not all the same. Although, they were treated very similarly. As previously mentioned, the spur, being a calcification on the bottom front of the calcanius, plantar fasciitis deals with the plantar fascia tendon, which is hundreds of fibrous strands spreading from it�s insertion at the calcanius to the metatarsal heads. Adding to the equation individual biomechanical factors, such as: feet that pronate (roll in), supinate (roll out), weakened ankles, extra body weight, improper footwear, loss of the body�s natural shock absorbers, flattened or dropped arches, cavus or high arched feet in a weakened condition, and you have the recipe for a painful mess.
Plantar Fasciitis has been given the dubious distinction of covering a multitude of these problems, as long as heel pain is present. Yes, whenever pain is present at the center of the heel or at the medial tuberosity, you can be certain plantar fasciitis was the diagnosis. As time went on, treatment for this ailment became more sophisticated. Usage of therapeutic equipment, such as ultrasound, showed some promising signs of helping a certain percentage of patients with heel pain, but overall the percentage of patients remained small. Orthotisists (brace makers), put their spin on the cure by developing night splints used in severe cases to help stretch the plantar fascia tendon. I saw nothing that was helping almost everyone, and heard complaints from patients who had already seen more professionals for heel pain than they cared to admit.
It was now the mid 1990’s and I was working as the chief Pedorthist at an HMO. I was seeing a large number of patients with heel pain. I had developed my own program of dealing with most of the heel pain utilizing extra supportive ugly orthopedic shoes, and (built up) arch supports. If any residual pain persisted, I sent the patient for a painful cortisone shot. This worked in 60-65 percent of the cases, and was widely accepted by the HMO as the form of treatment at that time. A large portion of patients seen by podiatrists, physicians and physical therapists were not progressing the way they [patients and professionals] thought they should.
In the early 1990’s, I had a patient came into my office after seeing four or five physicians for heel pain, she�d had several injections of harmful steroidal painkilling drugs, and was in fear of having to live with this debilitating heel pain. This active person, worked as a lobbyist for the US Senate in Washington DC. She was neither interested, nor could she wear orthopedic looking shoes. She was expected to dress the part wearing dressy shoes with heels in her very public, prestigious job. She and I talked at some length about all the time and effort she and her caregivers put into solving her problem, and how nothing was working satisfactorily. She knew she felt slightly better in high heels than in flat heels. This was mainly because she was placing more weight on the balls of her feet and quite a bit less on her heels. There is a lesson to be learned here. If we could somehow reduce the walking pressure on the patients� heels, could we reduce the pain? Knowing that the pressure was reduced because of the high heels was not enough. I previously experimented with practitioner applied pressure techniques. Using the body�s own internal energy system (kinesiology) to help and reduce pain naturally.
I took a fresh look at the skeletal foot, and found that the heel pain was almost always located behind or in front of the proximal fascia tuberosity (rear plantar fascia insertion). For years, during exams, patient�s heel pain was easily identified and palpitated. I began experimenting with acupressure during exam after locating the heel pain. I asked each patient, once I applied acupressure, weather the pain was less, the same, or greater, and to my surprise, 90 percent of the time, it was less, much less. However, once finger pressure was released, no long term positive or negative effect on the pain was noted. Naturally, it was something to do with applied acupressure, and obviously, the key was the location of that pressure. The challenge was harnessing all this information and developing something to recreate my applied finger pressure in the patient�s shoe. First we needed to find out if some how simulated when walked on, this relief pressure would show any long term positive effects on the patients heel pain.
So to bring this full circle, I contacted the woman form DC, and had her come back to my office. She and I spoke about her wearing a bar like device attached directly to her foot, which while walking, would simulate the pressure relief technique that I used in the initial exam. I told her to do everything she normally would, and come back in three weeks. During this three week period, we had absolutely no contact. Frankly, when she came into my office three weeks later, I did not know what to expect. I remember the chill I felt on the back of my neck when the patient immediately started thanking me, telling me I was genius. She was so excited about how great this technique worked and how something so little could do so much. I also remember how excited I got, when I examined her foot, a foot that�d had continuous pain for well over a year. I also recall she�d seen so many professionals, and had numerous shots, several forms of therapy, you name it. With all that attention, she still had no relief. However, here she was now sitting in front of me only three weeks after her one and only visit, telling me she was feeling systemically pain free. Through the exam, I was hard pressed to find any significant pain. This was unbelievable! After our visit and she was leaving, while walking in the hallway of the HMO, she saw her doctor and told him of her very exciting experience. He told her he was pleased that her heel pain was miraculously gone. We began immediately devising and testing a variety of forms that would eventually become the HTP Heel Seat.
The subject of the product cushioning the heel pain is always an issue. Why not just put heaps of cushioning under the heel to absorb shock at total heel strike? That�s exactly what most practitioners recommended initially as part of, or, as their conservative method of treatment program for heel pain. Most heel pain products are made of either extremely spongy foam (same as was available in the 1960’s) firm PVC rubber like heel cups with a corrugated bottom to high point its shock absorption, and probably the most satisfying looking heel seats are made of clear gel. The latter created a look and feel of the human fat pad. This is becoming the largest recommended product for early treatment, but is gel or any other cushioning material justifiable?
A study was done at a New York City medical school to find a product, or material, which would most closely simulate the human heel�s own fat pad and that, would absorb shock accordingly. Hundreds of materials, foams, gels, poly-foams, and other materials from all over the world were tested against the human heel�s fat pad. The fat pads were taken from several cadavers. Tests were done to note any significant differences from one cadaver�s fat pad to another, in regard to the shock absorption. Amazingly, very few differences, if any, were found. More importantly, no product made by or known to man even came even close to the shock absorbance of man�s own fat pad. Adjusting for slight deviations, the study showed at best that the closest a man made material came, was less than a third of the ability to absorb shock, versus the human heel fat pad. This lessened over prolonged usage on even the most promising materials. The same was not true of the human fat pad. The amount of shock absorption remained consistent. The conclusion of the study was that no product was going to solve the problem solely by adding shock absorption to the patients� heels.
This test lent credence to the development of our own concept product, �Heel That Pain�, due to the fact that the product didn�t rely on heel cushioning to solve or stop the existing heel pain. There was an immediate acknowledgement that not only were we correct on this matter (shock absorption was not truly the answer), but the test gave us further knowledge of how our product was indeed working
Since the mid 1980’s, our office has seen thousands of patients for many different foot problems and discomforts. The largest group, approximately 38 percent, suffered from heel pain of various types and varying degrees of intensity. Most of those who�d suffered heel pain, had suffered from about two months to as long as three years. Combining all fasciitis bar treatment forms previously mentioned, we have successfully treated all heel pain patients. For the most difficult patient, adjusting to the height of the fasciitis bar was generally the only variable, and this was incorporated into custom orthosis. In the largest percentage of cases, however, the acupressure fasciitis bar was significant enough, on its own, to relieve heel pain in short order (in three to eight weeks).
Amazingly, the patients were relieving the pain and curing the pain by doing what had originally been causing the pain, i.e. walking, and encouraging the benefits of our products. Most notably, during this time, not one patient in approximately fifteen years of testing or usage (that we know about) was lost to surgery. A small percentage, less than 1 percent, who had compartmental painful heel syndrome needed cortisone shots. All patients were given a combination of fasciitis bar usage and appropriate daily exercises to complete and cure the heel pain. In any practice, it is in my opinion that it is more flattering to receive patient referrals, than any other type. This, to me, is a great indication that what we�re doing for the patients is working. In no area is this more obvious to our office, than with those patients that have been treated for heel pain. Their approval is my reward. Just see the hundreds of testimonials from people just like you!