Treating Heel Pain

Peter Wishnie, D.P.M.
Owner of Family Foot & Ankle Specialists in Piscataway & Hillsborough, NJ

Treatment of Heel Pain
There are many different ways to treat heel pain. You and your doctor will decide on the best treatment plan based on your activity level, work environment, and other factors. Below we listed a few of the option we have available in our office:

1. Rest-
 It is better to rest the heel as much as practicable. When you are off your feet, the injury is healing and getting better. When you are standing, without any foot support, the heel is getting injured further. When you are standing when wearing orthotics (foot supports) and well supportive shoes, the injury decreases dramatically, but usually is not eliminated altogether. So, during the treatment period, if you have the choice of sitting or standing, sit ! If there are no health reasons to avoid them, a week's use of an over-the-counter anti-inflammatory medication may eliminate the pain.


2. Support- First, we need to protect the bone from the pulling of the plantar fascia. We do this by using an arch supporting device - an orthotic. They come in pairs, one for each foot. Orthotics will greatly reduce the pain now and in the future. Athletes, people who stand during work, or those with heel pain need a custom orthotic to relieve the pressure and support the foot.

3. Stretching-the tissue on the bottom of the foot. Three times a day, sit erect with the legs extended and loop a belt, scarf or towel around the forefoot. Pull the forefoot toward the upper leg. Expect to feel a mild pulling sensation at the back of the leg and in the arch. Stretching should not be done to the point of pain. This position is held for 30 seconds, and is repeated 3 times. The 3 repetitions at 30 seconds, 3 times-a-day is easy to remember. 

4. Physical therapy- For physical therapy, the doctor may employ ultrasound, galvanic stimulation or any of a number of anti-inflammatory modalities in the office or at the offices of a physical therapist. The most effective way for physical therapy to work is if it is applied regularly, at least three times a week. 

5. Laser Therapy- Laser therapy has proven very successful at treating heel pain. This painless procedure sends oxygen and other healing agents to the point of injury in the body increasing recovery time and reducing inflammation. 


6. Cortisone injections- usually done at weekly intervals, and most cases require 1-3 injections. The skin can be desensitized before the injection with a cold freezing spray designed to provide brief anesthesia. The injection is done from the inner side of the heel, not from the bottom.  

7. Shoes- Without proper shoes or ill-fitting shoes, your feet can be in serious danger. Shoes have the power to create or eliminate pain in the feet. You need to have proper fitting shoes, shoes that adhere to your foot type, and shoes that match the activity you're involved in. 

These measures will eliminate the problem in about 85% of patients within 3 weeks. Some get better quickly, others take the full 3 weeks. 

8. Surgery
- becomes necessary for the few who do not benefit from treatment. If the problem is due only to the inflamed fascia, the easiest procedure involves lengthening the fascia near the heel. The procedure is often done endoscopically today, through tiny incisions, using a small television camera inside the heel, very much like most knee surgery is done. 


Preventing Heel Pain
Recurrence is rare after treatment, if the patient continues to employ good mechanical foot control by continuing to wear orthotics and good supportive walking or athletic shoes. Recovery is rapid and the success rate is better than 90%.  
 


To watch a 2 minute video on treatment options click here.