Who should I see first with heel pain?


Many times I see patients that come into the office and they've been dealing with it for six months and they've told their internist or their primary care doctor or the internal medicine doctor about their foot condition. They've talked to their physical therapist and they've had some physical therapy. They've tried some stretching, but nothing gets them better. My recommendation is when you have heel pain, you should see your podiatrist first. Because you’re able to get better the quickest and fastest. The challenge is, if you delay and the longer you delay in coming, the more chronic it can get and the more difficult it can be to treat it. So at the first sign of pain, it’s good to go and see the professional and not just look for answers online. What we put here are good resources, but they’re not the solution for everyone.

To Your Health,
Dr. Donald Pelto

I'am confused about heel pain. There are too many treatment options.


Many patients come to us at Central Massachusetts Podiatry after seeing many other physicians.  Maybe they've seen their primary care doctor, they've talked to their physical therapist, they've talked to their best friend that got better with heel pain, and they've googled the issue of heel pain on the internet.  They get overwhelmed with so many treatment options. If you Google heel pain, you’re going to find 1,001 things for sale and 1,001 treatment options.  My objective is to reduce the complexity and increase the simplicity to get people better quicker.  I've developed a treatment protocol for heel pain, and what I find, simply put, is that there are three things that help people get better faster. The first is you have to reduce the inflammation. That is why you have the pain in the heel. The way to reduce the inflammation is to ice the area and use an anti-inflammatory, or do a cortisone injection. Usually people try the first two, the icing and anti-inflammatory before they see me.  When they come and see me, everyone who will allow me will get a cortisone injection. The next phase to get better is to loosen up the tight calf muscles. The muscles in the calf or even higher up in the thigh or the psoas can cause changes in the way that you walk and tightness in the calf. It can cause the foot to move differently and increase pressure on the plantar fascia.  So you have to loosen up the calf muscles.  This can be done with stretching. Most people try that before they come and see me, but I really recommend either the Graston technique with physical therapists or I recommend deep tissue massage with trigger point tools. These are tools that you can use at home, whether it be a specialized form roller or some other tools that can penetrate deep into the back of the calf and reduce any of the adhesions. Make sure that when you’re doing that you hydrate yourself well enough. If that’s not enough, then you have to go to skilled physical therapy.  The third treatment is to stabilize the heel position. What I didn't say is get an arch support.  What I say is you need to stabilize the heel position so your foot isn't moving too much to cause increased strain on the plantar fascia or on the tendons in the back of the leg.  The two best ways of doing in this, in my opinion, are a nice stable sneaker, I usually recommend New Balance or Asics, or a custom orthotic that can help move the position of your heel into the proper position so you can get better quicker. In summary, the best way to get better is to do these three things: Reduce inflammation, loosen the calf muscles, and stabilize the heel position. Usually when we’re able to do that, we’re able to get a large portion of our patients better with heel pain. That’s not always the case for everyone because there are other diagnoses that you have to rule out and just because someone had a treatment from someone else, for example an orthotic, an injection or different things, we don’t know if they were applied in the proper position or done in the proper way.

To Your Health,
Dr. Donald Pelto

When is a shot for heel pain needed?


Oh, the dreaded shot! No one likes a cortisone injection when they have plantar fasciitis. Many people come in and they say, “I will do anything, but I don’t want a cortisone.” The way I explain cortisone to people is that you’re going to walk in with pain and you’re going to walk out pain-free. That happens about 90% of the time with people with plantar fasciitis. That doesn't mean that that one cortisone injection is going to take away all the pain forever, but it’s what we call therapeutic and diagnostic.  So let me explain a little bit more.  Therapeutic means you’re going to have some type of therapy that will help you get better and it’s going to take away some of the inflammation, it’s going to take away the pain because of the Novocain, but it may last for a couple of weeks or a couple of months. Then I also say that it’s diagnostic.  When it’s diagnostic, it helps me determine that that’s the cause of plantar fasciitis. By putting the medicine in there, if it numbs it up and makes the pain go away, then I can confirm that diagnosis.  So a shot is usually needed for heel pain after you've tried things that didn't work; after you've tried icing, anti-inflammatories, stretching, physical therapy, or even if you come to see us on the first visit, I find that a cortisone injection is the quickest way to get relief for patients.

To Your Health,
Dr. Donald Pelto

My heel pain went away but came back!



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This is a typical situation that I hear with many patients. They come in to our practice in Worcester, Massachusetts, and they have had plantar fasciitis, and either they've treated it on their own with some stretching and physical therapy and then it goes away, but then it comes right back. Or they have had a cortisone injection, it goes away for a little bit, but then the pain comes back again. What I find is that in order to treat plantar fasciitis, the best way is the three-component method. You have to reduce the inflammation, you have to loosen up the calf muscles, and you have to stabilize the heel. When doing those three together, you have a much greater chance of heel pain not coming back.  So if your heel pain does come back, you should probably see a professional, see a podiatrist that can help you and go over the treatment protocol for heel pain.

To Your Health,
Dr. Donald Pelto

When are orthotics needed for heel pain?


Many of my patients come in and they've already tried icing, they've tried anti-inflammatories, they've tried other types of treatments for their heel pain and they’re not getting better. I tend to explain to patients that orthotics are usually the first line of treatment after you've tried some other things.  For example, I explain for treating heel pain there are three components. You have to reduce the inflammation, you have to loosen up the calf muscles and you have to stabilize the heel.  They all work in conjunction and if you've already tried a cortisone injection and anti-inflammatories and ice to reduce the inflammation and you’re doing physical therapy or deep tissue massage to the back of the calves, and you've tried good shoes, then that’s the time to use custom orthotics, especially if your heel position is unstable or if the heel goes in or outward. That can be very beneficial.  So in my opinion I don’t think everyone needs orthotics, but if you've already tried other things, a custom orthotic tends to be very helpful.  Bear in mind that a custom orthotic is different than an over-the-counter insert.  An over-the-counter insert isn't able to stabilize the heel.  They usually just give a cushion in the heel and a little arch support.  

To Your Health,
Dr. Donald Pelto

When is heel pain not plantar fasciitis?



Many patients come in to the office and they have been dealing with what they think is plantar fasciitis for many months or many years, only to find out that the condition isn't plantar fasciitis.  Some of the more common conditions are calcaneal bursitis. This is a problem where you have inflammation around the bursa on the bottom of the heel that can sometimes be caused by a heel spur, but otherwise it is a liquid formation protecting the heel, and this is different than plantar fasciitis and can sometimes be found in conjunction with plantar fasciitis.  Another problem that is common with plantar fasciitis or similar is something called flexor hallucis longus tenosynovitis.  This is a problem where the tendon that bends down your big toe gets inflamed and painful around that area. Another condition that is somewhat common is a nerve entrapment on the inside of the ankle region or inside of the heel region. If there is a nerve entrapped, it can cause heel pain, and when you numb up the nerve the heel pain goes away.  Those are just some of the other causes of heel pain that aren't plantar fasciitis.  

To Your Health,
Dr. Donald Pelto

Why is correcting heel position so important with heel pain?


Many of my patients that I see in the office in Worcester, Massachusetts for heel pain or plantar fasciitis are in need of orthotics that can help correct the heel position. When I talk about heel position, it is when you look at someone from the back, you can see their heel. Normally you want to look at the Achilles tendon, which is the tendon that goes from the back of the heel up the leg. That should be very straight.  If it’s slanting to the right or to the left, that means that person is maybe flattening out too much, or going inward too much, and that can be a problem. If you are able to correct the heel position or put it to where it should be in the center, there is not excess movement in the foot that can put strain on the plantar fascia or on the tendons on the back of the leg. Therefore, correcting heel position with a good supportive sneaker and an orthotic is very important to help heal plantar fasciitis as well as prevent it from coming back. The absolute worst type of shoe to wear is a flip flop when you have heel pain because it does not allow for any stability.  

To Your Health,
Dr. Donald Pelto