Admit it: You never give your heels a second thought. Not until the day you hop out of bed, yelp and freeze: someone, it seems, has poked a red-hot stiletto (not the Manolo kind) into your very sole! Gimpy but resolute, you totter a few paces and the pain subsides. But at that evening's gala it strikes again. You hobble home early.
You've joined the legions of people with heel pain. Don't despair: effective treatments exist, including a brilliant new therapy for nightmarish cases. Most likely, your doctor will diagnose your complaint as plantar fasciitis (fa-she-i'-tis). You'll learn that the old song is right: The toe bone is connected to the heel bone, by the plantar fascia, a length of fibrous tissue that is stretched bowstring-taut between the two and is susceptible to inflammation and small but agonizing tears. "Plantar fasciitis is the most common condition I see; more than one million people a year suffer from it," says Manhattan podiatrist Paul M. Greenberg. In part, he says, we're victims of civilization. "The foot didn't evolve for walking on pavement; it was intended for walking on grassy plains. Treading on non-shock-absorbing surfaces puts a lot of stress on the foot, which contributes to plantar fasciitis."
Though you may need to hang up your mile-high Jimmy Choos for a bit, chances are conventional treatments will soon have you back on your feet. Taking anti-inflammatory medication is the first line of defense, along with wearing support shoes with a one-inch heel, over-the-counter insoles (such as Spenco cross trainers), arch supports or heel pads. Even sitting for 10 minutes every hour helps. If you're a runner, decrease your mileage or switch to low-impact exercises. Treating the foot with ice several times daily for two weeks will ease soreness. There's also acupressure (applying pressure to the heel by rolling a golf or tennis ball under the arch of your foot while standing).
Still limping after four weeks? Your doctor may prescribe conservative therapies: cortisone shots, night splints (which hold the foot and ankle at a 90-degree angle), custom orthotics and/or physical therapy. (A recent study found that stretching the plantar fascia itself brings swifter relief than stretching the Achilles tendon, which is often advised.)
The 10 percent of sufferers whose heels defy these therapies for six months or more have two final options, surgery or orthopedic science's latest answer to heel pain: Extracorporeal Shock Wave Therapy (ESWT). A noninvasive, outpatient procedure, ESWT heals by directing high-energy sound waves to the painful area. "Its exact mechanism is not clear. We think that it retraumatizes the plantar fascia where it attaches to the heel bone," says Dr. Lehman. "Your body reacts by creating more blood vessels there, which bring in extra nutrients and oxygen to help with healing. This also happens in surgery: You traumatize the plantar fascia's point of insertion in the heel bone by cutting it so that healing will then take place." (Of course, recovery from surgery takes longer.)
ESWT comes in high- and low-energy forms: The latter requires no anesthesia and takes several sessions; the high-energy form requires local anesthesia but takes only one. (ESWT is not for pregnant women, children or those with pacemakers or a history of bleeding problems.) Lehman and other physicians prescribe it not only for plantar fasciitis and tennis elbow, its approved uses, but also for rotator cuff bursitis, patellar tendonitis and stress fractures.
ESWT's effect on heel pain is dramatic: 80 to 90 percent of patients report relief. Manhattan mortgage broker Ellen Paternoster says, "I was running 25 miles a week when I developed horrible foot pain." Conservative treatments failed. When Dr. Greenberg suggested ESWT, Paternoster readily agreed. "At that point, my foot hurt even when I was seated. It was too painful to do anything."
The cost of ESWT ranges from $1,500 to $2,500, and many more insurance providers are covering the procedure now that it's becoming standard. "The treatment took an hour or so, and I walked back to work," Paternoster says. "To walk again without pain was definitely worth it." It's been 11 months since her treatment. "I feel great now. Frankly, I can't even remember which foot it was."
Excerpted from the March 2004 issue.
Bring home the tradition of elegant living! 
