Heel pain requires a comprehensive exam for an accurate diagnosis. The most common cause of heel pain is plantar fasciitis. According to the American College of Foot and Ankle Surgeons, “plantar heel pain is the most prevalent complaint presenting to foot and ankle specialists and may be seen in upwards of 11%-15% of adults”. The first thing people should do for heel pain is evaluated their shoes, avoid going barefoot and evaluate any activity that could be contributing to the problem. Below are some other treatment options for plantar fasciitis. If your problem is with the Achilles tendon or involves a fracture of the heel the treatments would be different. I will focus on plantar fasciitis treatment here as it is the most common cause of plantar heel pain.
The common treatments for plantar fasciitis include the following:
Stretching
Stretching and icing will make a tremendous difference and should be the first line of treatment. Below are a couple of options. I have found that the Prostretch device seen below is great for plantar fasciitis, arch pain, and even tendonitis. People just need to be careful not to overstretch with Achilles tendonitis. If it hurts, you need to back off a little. The pro stretch device can be purchased online or in our office.
Orthotics
Either over-the-counter devices such as Powersteps or Superfeet, or a custom orthotic. A custom orthotic is used to support the arch and realign the foot/ankle. In my office, I use digital casting by a company called Pedalign. I have used foam impression, plaster casts and now digital scanning to make orthotics. A true digital scan makes a very accurate device and allows me to add custom modifications very easily with the click of a button. Remember that the “custom orthotic” you get from the fancy machine at Walmart is not custom at all. It is quite misleading actually. A custom device needs to be fabricated by a lab after an accurate scan is made of your foot, with modifications being made after an exam by a qualified podiatrist.
Brace Support
Sometimes a brace will be used during the day to support the foot/arch.
Night Splints
A night splint can be used for patients in cases of a tight Achilles tendon. A night splint is a brace used while you sleep that will eliminate the pain when you first get out of bed in the morning. There are many variations. Some go behind the ankle and some over the top of the foot and ankle. I find most people prefer one over the front of the ankle.
Cortisone Injection
A cortisone injection can be given to help reduce swelling.
Physical Therapy
At times, physical therapy can be used with great success.
Medication
There are benefits to oral medication, such as anti-inflammatory medication like ibuprofen or oral steroids, in certain cases.
Cam Walker & Casts
A cam walker or cast can be used to rest the foot.
Extracorporeal Shock Wave Therapy
Some people with resistant plantar fasciitis will benefit greatly from extracorporeal shock wave therapy (ESWT).
Dry Needling
A new treatment for resistant plantar fasciitis which can be very successful in the right patient.
Topaz Procedure
Topaz is a procedure that is done in a hospital/surgery center where a probe is used to puncture the plantar fascia and heat stimulates healing. It is similar to dry needling but uses radiofrequency ablation in addition to tissue injury as with dry needling.
ESWT
During shockwave therapy, a special probe is used to deliver pressure waves to the skin. These waves travel throughout the skin until they reach inflamed tissue. They trigger the body's natural healing process, which causes new blood vessels to form. This increases the oxygen and blood supply in the area, resulting in decreased inflammation and the regeneration of healthy cells. The process also helps your body produce collagen, which is vital to the health of connective tissue. The procedure is quick and easy. It usually takes just four visits and most patients experience pain relief immediately.
Stem Cell Injections
A stem cell injection will regenerate the damaged plantar fascia. In the Nashville area, Neuhaus Foot and Ankle podiatrists are the only advertising the use of stem cell injections.
Pros of Stem Cell Injection:
- Permanent solution
- Prevents further damage
- Natural healing of the body
- Low risk of infection because stem cells come from your own body
- Virtually pain free procedure
