Dr Chee Yu Han Mr Supapong Supantamart E-mail your questions to [email protected]. Specify Ask The Experts as the subject and include your name, age, gender, identity card number and contact details. Consultant, division of foot & ankle surgery, department of orthopaedic surgery, National University Hospital Podiatrist, NUH Rehabilitation Centre AskTheExperts Q I am a 70-year-old man. I have had pain in my heel for five years. It started with my left heel. The pain subsided after I used ready-made insoles. But, a year ago, I felt pain in my right heel. I have tried various ready-made insoles. I use slippers with thicker heels and higher arches. But the pain is still there. I recently bought a pair of made-to-order insoles. I was told I have an arch problem on my right foot and I am flat-footed on the left. I don’t feel the pain in the arch but there is pain in my heel cup. I have tried to stand on my toes for one minute daily and swim once a week. Unfortunately, the pain continues to come and go. I weigh about 75kg and, based on my BMI, I should reduce my weight to 67.8 to 71.6kg. What can I do? A Heel pain can affect everyone. There are many possible causes, such as stress fracture of the heel bone, bursitis and connective tissue injury. Treatment options differ, depend- ing on the cause. You have described taking positive steps towards treating the condition. However, it is unclear if the advice was given by a trained healthcare professional. It is possible that you might have performed the steps inaccurately. This could be the reason the pain is still there. If you have not sought profes- sional help, we suggest that you see a general practitioner (GP) to assess your condition more accu- rately. The GP will refer you to a specialist, if necessary. Specialists like orthopaedic sur- geons will usually ask for an X-ray of the foot to check for the presence of bony spurs (bony growths) around the heel bone. The severity of conditions such as plantar fasciitis and Achilles ten- don degeneration can be assessed from the size and location of bony spurs in the heel bone. The condition that you have could be plantar fasciitis, which affects many people. This is caused by the degen- eration and inflammation of the thick band of tissue (ligament) that runs along the sole of your foot. Painkillers may be prescribed and you may be advised to lose some weight to help reduce the stress on your feet. You may be referred to the podiatrist for non-invasive treat- ment to ease the pain. The podiatrist will do a thorough foot assessment, teach you proper stretching exercises, provide pre- fabricated or custom-made insoles, give advice on appropriate foot- wear as well as help you modify your lifestyle and activities that might aggravate the pain. Alternative treatments, such as therapeutic ultrasound or shock- wave therapy, can be considered if the first-line treatment is insuffi- cient. The rationale of wearing insoles is to support the painful foot and reduce excessive pulling of the connective tissue that is linked to the heel bone. However, merely fitting the patient with a pair of insoles will not suffice as it is only a small part of a comprehensive heel-pain treatment plan. If the patient does not respond well to conservative management methods and the pain persists, the orthopaedic surgeon will offer a platelet-rich plasma (PRP) injec- tion – which is drawn from the patient’s blood – into the area where there is maximum pain. This allows the degenerated plantar fascia to gradually recover by regenerating new tissue, which results in permanent pain relief. This procedure carries minimum risk and is better than using steroid injections to relieve the pain. The latter can result in a weakened plantar fascia ligament, which could then rupture. Many patients have benefited from this procedure and are relieved of their pain after three to four weeks. Surgery will be offered as the last resort to “release” the plantar fascia. This involves key-hole surgery to cut the tight bands of the fascia. GOT A PROBLEM? Insoles not enough to treat heel pain el
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Dr Chee Yu Han
Mr SupapongSupantamart
E-mail your questionsto [email protected] Ask The Expertsas the subject and includeyour name, age, gender,identity card numberand contact details.
Consultant, division of foot & anklesurgery, department of orthopaedicsurgery, National University Hospital
Podiatrist,NUH Rehabilitation Centre
AskTheExperts
Tay Hong Yi
There was no heartbeat detected inher womb, her doctor had said.
It was the second unborn babythat Ms Farnizah Minsawi had lost,due to her frequent falls whenevershe had epileptic seizures.
Ms Farnizah, 40, works at themobile library kiosk of EunosCommunity Club.
She has a son, now 17, and adaughter, now 15, who were bornbefore the two miscarriages.
During her own infancy, a highfever had left her with epilepsy. Atage six, she was diagnosed with thecondition at the National Neuro-science Institute (NNI), where shestill goes for follow-up checks.
Epilepsy is a neurological dis-order characterised by suddensurges in brain electrical activity,which manifest as seizures.
More than 20,000 Singaporeanslive with it and the severity of sei-zures varies between individuals.
For Ms Farnizah, intense seizureslasting up to three minutes are aregular occurrence.
She said through a Malay inter-preter: “After the birth of my firstchild, my seizures started to strikemonthly, always around the sametime as my period.”
Dr Sheila Srinivasan, a consultantat the NNI’s department of neuro-logy, said it is common for seizuresto coincide with the menstrualperiod, due to hormonal changes.
Ms Farnizah’s seizures arecharacterised by a vague feeling ofunease which rapidly progressesinto a fit that dulls her sense of painand balance. Sometimes, the
episodes left her disoriented andwith bruises that she had norecollection of.
But a prominent reminder ofthese episodes is a thick scar acrossher left forearm, pressed into herflesh by the rim of a hot frying pan.
She does not remember the yearbut said she was cooking at herparents-in-law’s home when aseizure struck.
“I tried to suppress it, butcouldn’t,” she added.
Fortunately, her brother-in-lawwas at home and heard the clang ofthe falling pan.
She said: “He turned off theflame, cleaned everything up andwaited for me to recover.”
Despite taking the anti-epilepticdrug Epilim and folic acid supple-ments, her condition is only underpartial control.
In fact, the seizures gradually gotworse after the birth of her firstchild. They have also caused her tobecome incontinent since last year.
Due to her sub-optimal responseto medication, the doctor proposedsurgery, but Ms Farnizah and herfamily objected to the suggestion.
Her epilepsy has caused hermarriage to break down. Herhusband divorced her five yearsago after 10 years of marriage.
She has custody or her twochildren and is left to provide forthem and her parents.
She said: “My father has retired,but he is now working part-time.”
Her salary is between $400 and$500 a month and she is not onsocial assistance.
Her children receive free schooluniforms and education subsidies.
Still, she might not even have a
steady income if not for an interimjob scheme, underscoring thedifficulties faced by epilepsysufferers in getting a job.
She is employed under the NorthEast Community DevelopmentCouncil’s (CDC) Community Em-ployment Programme, which paysa minimal stipend to people seek-ing permanent work.
According to a North East CDCrepresentative, a total of 1,700people have benefited from theprogramme since it started in 2011.
They are employed for up to sixmonths, but Ms Farnizah was givenan extension as she is still unable tofind a job.
She has been under the pro-gramme for most of the last fiveyears.
Her short stints as a petrol kioskcashier would often end when shehad seizures on the job.
She has stopped declaring hercondition on job applications afterrealising that firms are unwilling tohire her, even though the doctor
has certified her fit for work. “Em-ployers said they were concernedabout the insurance,” she said.
Despite the discrimination shehas faced in her search for a job, sheis optimistic that she will find apermanent job.
Has she ever succumbed to nega-tive thoughts?
“I have always wished that I didnot have epileptic seizures,” shesaid with tears in her eyes.
Q I am a 70-year-old man. I havehad pain in my heel for five years.
It started with my left heel.The pain subsided after I usedready-made insoles. But, a yearago, I felt pain in my right heel.
I have tried various ready-madeinsoles. I use slippers withthicker heels and higher arches.But the pain is still there.
I recently bought a pair ofmade-to-order insoles. I was toldI have an arch problem on my rightfoot and I am flat-footed on the left.
I don’t feel the pain in the archbut there is pain in my heel cup.
I have tried to stand on my toesfor one minute daily and swim
once a week. Unfortunately, thepain continues to come and go.
I weigh about 75kg and, based onmy BMI, I should reduce my weightto 67.8 to 71.6kg. What can I do?
A Heel pain can affect everyone.There are many possible causes,such as stress fracture of the heelbone, bursitis and connectivetissue injury.
Treatment options differ, depend-ing on the cause.
You have described takingpositive steps towards treating thecondition.
However, it is unclear if theadvice was given by a trained
healthcare professional. It ispossible that you might haveperformed the steps inaccurately.This could be the reason the pain isstill there.
If you have not sought profes-sional help, we suggest that you seea general practitioner (GP) toassess your condition more accu-rately. The GP will refer you to aspecialist, if necessary.
Specialists like orthopaedic sur-geons will usually ask for an X-rayof the foot to check for the presenceof bony spurs (bony growths)around the heel bone.
The severity of conditions such asplantar fasciitis and Achilles ten-don degeneration can be assessedfrom the size and location of bonyspurs in the heel bone.
The condition that you havecould be plantar fasciitis, whichaffects many people.
This is caused by the degen-eration and inflammation of thethick band of tissue (ligament) thatruns along the sole of your foot.
Painkillers may be prescribedand you may be advised to losesome weight to help reduce thestress on your feet.
You may be referred to thepodiatrist for non-invasive treat-ment to ease the pain.
The podiatrist will do a thoroughfoot assessment, teach you properstretching exercises, provide pre-fabricated or custom-made insoles,give advice on appropriate foot-wear as well as help you modifyyour lifestyle and activities thatmight aggravate the pain.
Alternative treatments, such astherapeutic ultrasound or shock-wave therapy, can be considered ifthe first-line treatment is insuffi-cient.
The rationale of wearing insolesis to support the painful foot andreduce excessive pulling of theconnective tissue that is linked tothe heel bone. However, merelyfitting the patient with a pair ofinsoles will not suffice as it is only asmall part of a comprehensive
heel-pain treatment plan.If the patient does not respond
well to conservative managementmethods and the pain persists, theorthopaedic surgeon will offer aplatelet-rich plasma (PRP) injec-tion – which is drawn from thepatient’s blood – into the areawhere there is maximum pain.
This allows the degeneratedplantar fascia to gradually recoverby regenerating new tissue, whichresults in permanent pain relief.
This procedure carries minimumrisk and is better than using steroidinjections to relieve the pain. Thelatter can result in a weakenedplantar fascia ligament, whichcould then rupture.
Many patients have benefitedfrom this procedure and arerelieved of their pain after three tofour weeks.
Surgery will be offered as the lastresort to “release” the plantarfascia. This involves key-holesurgery to cut the tight bands of thefascia.
GOT A PROBLEM?
Ms Farnizah works at the mobile library kiosk of Eunos Community Club under the CDC Community Employment Programme. ST PHOTO: JONATHAN CHOO
Optimismin the faceof epilepsyMs Farnizah Minsawi still hopes she canfind a permanent job to support the family
HEALTHWISH
I have always wishedthat I did not haveepileptic seizures.
’’MSFARNIZAH MINSAWI, whohashad two miscarriages, and numerousfalls and self-inflicted injuriesdue to the condition.
Insoles not enoughto treat heel pain
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