Treatment for Heel Pain
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 evaluate 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 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 over stretch with Achilles tendonitis. If it hurts, you need to back off a little. The prostretch device can be purchased online or in our office.
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.
Sometimes a brace will be used during the day to support the foot/arch.
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.
A cortisone injection can be given to help reduce swelling.
At times, physical therapy can be used with great success.
There are benefits to oral medication, such as anti-inflammatory medication like ibuprofen or oral steroids, in certain cases.
A cam walker or cast can be used to rest the foot.
Some people with resistant plantar fasciitis will benefit greatly from extracorporeal shock wave therapy (ESWT).
A new treatment for resistant plantar fasciitis which can be very successful in the right patient.
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.
Injection of Autologous Platelet Concentrate (APC) holds much promise. This is a fairly new and expensive procedure in which blood is drawn from a patient, platelets and other healing factors from the blood are then isolated and re-injected back into the foot in the area of pain. It has been shown to be very successful in plantar fasciitis and Achilles tendon problems. The drawback is cost (it is not covered by insurance) and lack of long term studies proving it works. For more information, you can read this article in PodiatryToday: Platelet Rich Plasma: Can It Have An Impact For Tendinosis and Plantar Fasciosis?
NeuroTherm is a procedure that is used when the cause of plantar heel pain is due to a nerve entrapment. Neurotherm is a procedure done in the office under local anesthesia which eliminates pain caused from the nerve. It is utilized when the problem is not plantar fascia in origin but nerve related.
Cryotherapy is a procedure very similar to NeuroTherm. It involves using a probe which is inserted into the area of suspected nerve entrapment. It is used to freeze the nerve. The only problem I have with the procedure is there is no way to ensure you are on the nerve. It is the operator’s best guess. With the NeuroTherm procedure, you are using a nerve stimulator which virtually assures you are in the correct location. With the development of NeuroTherm, I see no use for the cryotherapy. NeuroTherm is much more precise and more effective.
Rarely will people need to go the operating room for surgery to eliminate heel pain. Heel pain that could require surgery can include diagnosis of tarsal tunnel syndrome, Haglund’s deformity, heel spurs, bone tumors and fractures.
The important point is heel pain is not normal and you do not have to live with pain. Treatment is typically very effective and in a relatively short period of time most people are living their lives pain free. However, the longer one has heel pain, the longer it may take to eliminate it. To learn more about some treatment options click on the following.