Questions On Foot Spurs & Headaches

Dear Dr. Spence,
I have been having significant foot pain at the heel. Do I need surgery to treat "spurs" or is there something else I can do?
Signed,
Heelp

Dear Heelp,
It sounds as if you may be suffering from plantar fasciitis, a chronic irritation of the fibrous tissue that connects at the base of the heel. Patients like yourself tend to complain of heel pain often described as a tearing type sensation that is worse upon waking in the morning and taking that first step. Interestingly, it really doesn’t seem to matter what the ultimate treatment is, the natural course of plantar fasciitis predicts complete resolution within about nine to twelve months. Generally, spurs do not contribute to the ailment. Treatment can be difficult. In my office, I advocate use of heel cup inserts as first line treatment. Other options include anti-inflammatory agents, stretching exercises, night splints and possible injections. In advanced cases, I will attempt off-loading and immobilization with walking boots/casts. Surgical intervention is rarely indicated but is certainly an option in those who fail to respond to traditional therapies.

Dear Dr. Spence,
I suffer from severe daily headaches. I have been told it may be my sinuses but medications have not helped? I take Motrin every day to no avail. Help!
Signed, Mi Grain

Dear Mi,
I suspect you may very well be the victim of migraines, which have now progressed to chronic daily headaches. Research suggests that patients presenting with this complaint in a primary care setting rarely suffer from sinus-associated headaches. More than likely, true migraines are the culprit. Your daily use of ibuprofen has undoubtedly complicated the clinical picture by precipitating a rebound phenomenon, a worsening of symptoms secondary to medication overuse. The more medication you use to treat your headache, the more likely you are to experience a snowball effect of increasingly frequent and intense headaches. Migraine management can be broken down into two components – acute migraine therapy and chronic preventative therapy. Acute therapy consists of migraine specific medications such as triptans (imitrex, maxalt etc.), which tend to resolve headaches in up to 60-70% of cases. Failure to respond to one agent in no way predicts potential response to another within the class. Of course, reduction in the use of over-the-counter medications will help prevent the development of chronic daily headache and rebound. All available medications have some potential to cause rebound. A subset of migraineurs may need preventative therapy due to the sheer frequency of their headaches. There are many drugs that have proven beneficial in these cases. Among these, beta-blockers (metoprolol, propranolol), antidepressants (amitriptyline), and anti-seizure medications (depakote, topamax) are used most commonly and are relatively inexpensive. They certainly decrease the frequency of migraine when used at appropriate doses. Though not necessarily indicated, I have used topamax short-term (one month or less) to abort the cycle of chronic daily headache. It seems to allow for a more rapid discontinuation of over-the-counter agents while triptans treat the acute attacks.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.