Treating Heel Pain
Introduction
The heel is the posterior prominence of the foot and it is the posterior projection of the calcaneus bone. It supports the calf muscles while walking and acts as a weight-bearing structure while standing. Overuse or trauma can cause heel pain which may range from mild and bearable to severely debilitating. Approximately two million people visit a healthcare professional for the treatment of heel pain. (1)
Causes of Heel Pain
There are several causes of heel pain; plantar fasciitis is the most common cause. Other differential diagnoses include calcaneal bursitis, Achilles tendonitis, calcaneal apophysitis, stress fracture, neuritis, tarsal tunnel syndrome, rheumatoid arthritis, ankylosing spondylitis, etc. (2),(3)
Diagnosis of Heel Pain
It is essential to get the heel pain evaluated by a doctor to obtain a diagnosis, receive treatment, and prevent long term damage and disability. A detailed history and examination along with imaging modalities such as x-rays are needed to determine the exact cause of the heel pain for proper treatment.
Visit Podiatry of Chicago (podiatrist) if you have experienced the following:
- Trauma to the foot
- The pain is severe and not relieved after rest and icing.
- There is redness or swelling.
- There is difficulty in walking or standing.
Treatment of Heel Pain – How To
Targeted treatment of heel pain depends on the cause but a few general guidelines are included in all treatment regimes, they are as follows:
Initial Treatment
Tier one treatment is the initial treatment for heel pain and includes lifestyle changes and medication.
- Lifestyle Modification
The doctor may recommend certain changes to the lifestyle, for the prevention of further damage to the heel and improvement of symptoms, they are as follows:
- Using comfortable and properly fitted shoes, wearing the appropriate footwear for sports activities, avoiding footwear that worsens the symptoms.
- Avoiding barefoot or sock-foot walking
- Using therapeutic insoles or custom orthotics.
- Reducing weight and maintaining the recommended BMI.
- Icing to help reduce inflammation
- Physiotherapy and stretch exercises to prevent pain and also to relieve it. The exercises depend on the cause of heel pain. (4)
- Conservative Management
Inflammation is one of the most common causes of heel pain. Anti-inflammatory drugs such as NSAIDs which include ibuprofen, naproxen, and aspirin help reduce the inflammation and also provide analgesia. Injectable corticosteroids can also be used to reduce inflammation. (4),(5)
Antibiotics may also be employed in case of infectious causes. (6)
If there is an improvement treatment is continued until the resolution of symptoms.
Tier Two Treatment
In the case of unsatisfactory response or no improvement, Podiatry of Chicago employs tier two treatment which includes continued tier-one treatment with additional therapies that depend on the cause. The following are included in tier two treatment ladders for heel pain.
- Immobilization is recommended for unresponsive pain. It can be done by a cast or by using a controlled ankle motion walker (CAM). (4)
- Night splints keep the foot in the anatomic position at night and help prevent contractures. (4),(7)
- Orthoses support the anatomic structure of the foot and prevent collapse. They are a cost-effective and comfortable treatment option. (8)
- Physical therapy referrals may be warrants to help reduce tightness in the calf or foot as well as massage therapy to work out excess scar tissue or inflammation.
The treatment options included in tier one and two are according to the most commonly employed treatment regimes. Certain tier two options can be utilized during initial therapy. (4)
Tier Three Treatment
Tier three is only used when there is no response to the tier two treatment. The common surgical options include the following:
- Fasciotomy
Plantar fasciotomy with or without heel spur resection is used to treat recalcitrant heel pain and has proven to be an effective option. (9)
- Extra Shock Wave Therapy
It is an effective non-surgical option to treat heel pain not responsive to therapy. (10)
Tendon debridement, calcaneal osteotomy, bipolar radiofrequency are a few other options that are available for treatment. (4)
Conclusion
Heel pain can cause disability, an abnormal gait, and may significantly decrease the quality of life of the affected individual. It is important to get it checked out so appropriate treatment can be given to stop the progression of the disease and prevent handicap. If you are experiencing heel pain, please call Podiatry of Chicago to schedule an appointment today.
References
- Landorf KB, Menz HB. Plantar heel pain and fasciitis. BMJ Clin Evid. 2008 Feb 5. 2008:[Medline].
- Agyekum EK, Ma K. Heel pain: A systematic review. Chin J Traumatol. 2015;18(3):164‐169.
- Tu P. Heel Pain: Diagnosis and Management. Am Fam Physician. 2018;97(2):86‐93.
- Thomas JL, Christensen JC, Kravitz SR, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49(3 Suppl): S1‐S19.
- D’Ambrosia RD. Conservative management of metatarsal and heel pain in the adult foot. Orthopedics. 1987;10(1):137‐142.
- Momodu II, Savaliya V. Septic Arthritis. [Updated 2019 Apr 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.
- Wapner KL, Sharkey PF. The use of night splints for treatment of recalcitrant plantar fasciitis. Foot Ankle. 1991;12(3):135‐137.
- Seligman DA, Dawson DR. Customized heel pads and soft orthotics to treat heel pain and plantar fasciitis. Arch Phys Med Rehabil. 2003;84(10):1564‐1567.
- Urovitz EP, Birk-Urovitz A, Birk-Urovitz E. Endoscopic plantar fasciotomy in the treatment of chronic heel pain. Can J Surg. 2008;51(4):281‐283.
- Thomson CE, Crawford F, Murray GD. The effectiveness of extracorporeal shock wave therapy for plantar heel pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2005;6:19. Published 2005 Apr 22.