I have had heel pain for almost 2 years. What can I do now?




Recently I had a patient come into the office in Worcester, Massachusetts and he had had heel pain for about two years.  It was a man and his wife made him come in because she was tired of listening to him complain.  Does that sound like anyone reading this blog article?  When he came in, he had been in pain for a long time. His pain was more in the morning when he got up, it got better as he started working, but towards the end of the day he had more pain. It was most painful after he went to drive in his car and got out of car, or when he rested at the end of the day and then got up again. Those are the typical symptoms for plantar fasciitis. The way we treated him to get him better is we gave him a cortisone injection into the bottom of the heel that instantly took away the pain in about two minutes and he walked out pain free. We gave him a grid, which is a foam roller for the back of the calf, to reduce any of the adhesions in there, and we also had him scanned for a pair of custom orthotics to help stabilize the heel.  That was the initial treatment. His plan was to see me back in three weeks to pick up the orthotics and come back a few more weeks later to see how things were going.  If things aren't progressing we may do another cortisone injection to reduce the inflammation. We may order physical therapy or we may have to modify the orthotics if needed. So that’s my typical treatment protocol for people with heel pain.

To Your Health,
Dr. Donald Pelto

Do I really need injection for heel pain?




Most of my patients come in, and when I go over my treatment protocol, they ask me, “Do I really need an injection for heel pain? Can I do anything else?”  Most people are willing to do anything in the world but get a cortisone injection. What I have to say to them is that a cortisone injection may be a little uncomfortable, but you’re going to leave without pain in your heel, and I can pretty much guarantee that. If you’re having pain in the heel after you get a cortisone injection, it may not be the right problem. It may not be plantar fasciitis or it may have been given in the wrong spot, or there may be more than one problem. A cortisone injection, in my opinion, is needed to get you better and it works the quickest.  If you don’t have that much pain, you may be able to get by with doing the other stuff, but for most people that’s very essential to get better.

To Your Health,
Dr. Donald Pelto

Where is a heel injection given for plantar fasciitis?


Many people when they come in to the doctor with heel pain, they tread the heel injection.  It makes sense because it’s quite painful for the most part. I want to explain a little bit more about the heel injection that we do for plantar fasciitis. There are usually, in our office, four components. We use a short and a long acting Novocain derivative and we also use a short and long acting steroid. For typical plantar fasciitis that’s on the bottom inside of the heel, I use a side approach on the inside of the heel, about 2 cm up and about 3 cm forward right where it’s hurting.  You infiltrate it right at the insertion of the plantar fascia into the bottom of the heel.  This creates kind of a sac in there, a sac of fluid, and that’s able to spread around to reduce the inflammation. If there are other problems, you may have to do it directly on the bottom or other places on the heel or ankle region to reduce the inflammation.  

To Your Health,
Dr. Donald Pelto

Can I try home therapy for heel pain?


Many patients ask me around Worcester when I meet them different places in public, “Well, I have heel pain. What can I do to get myself better at home?” The quick and easy way is to focus on the three aspects that are involved with treating heel pain. To make it very simple, you have to reduce the inflammation, loosen up the back of the calf, and stabilize the heel. So what you can try at home to reduce the inflammation is taking a bottle of water, putting it in the freezer and rolling it on the bottom of the heel to reduce the inflammation. Also, take anti-inflammatories like ibuprofen or naproxen if it is not contraindicated from your doctor. That’s a good way to reduce inflammation. If that doesn't work, then a cortisone injection done by your physician could help you. The second aspect is to reduce the tightness in the back of the calf. That can be done with some types of stretches you can find online, but I really like it when people use the trigger point tool therapy, which is either with a foam roller or the trigger point tools for the back of the calf that can penetrate deep into the back of the calf and reduce the adhesions in there and help them to feel better. If that’s not enough then you have to get a prescription for physical therapy from your physician. The third aspect is to stabilize the heel position.The best way is to throw out your old shoes or don’t wear your old shoes and get a new pair of either Asics or New Balance. I don’t recommend going cheap when you buy your shoes. Get something that’s good and stable and don’t just go for looks. I try to avoid the stylish shoes and go to something that’s going to be more comfortable. I always tell the women, this is for now, it’s not forever. So you’re going to be wearing some special shoes that are more athletic shoes for the time being until the inflammation gets better. If that doesn't work, you have to see your physician to get a custom orthotic that’s going to help correct your heel position. Make sure when you get an orthotic you don’t just get an over-the-counter one, but you need something that’s going to hold everything in the proper position.

To Your Health,
Dr. Donald Pelto

When is a cortisone shot needed for heel pain?


This is a question that I frequently get from my patients in Worcester, Massachusetts.  They want to know if a cortisone shot is needed for heel pain when they come and see a podiatrist. In my hands, if you have the typical plantar fasciitis where the pain is on the inside of the heel when you get up in the morning and then it gets a little bit better, and then when you sit down it hurts again when you get up, that responds very well to cortisone. In my opinion, when is it needed? As soon as you can get to the podiatrist. It’s very, very helpful and very, very effective. I wouldn't delay getting it, because it will just delay your recovery.  

To Your Health,
Dr. Donald Pelto

Why do they always give me stretching for my calf if my pain is in theheel?


Many patients with plantar fasciitis in the Worcester area are treated initially by their primary care or another doctor who always says, “When you have heel pain, try stretching.”  Stretching is a good option initially, but a lot of times it works better to do deep tissue massage to the back of the calf.  Let me explain why they recommend stretching. Stretching involves the back of the calf muscles and the plantar fascia, where the pain is in the bottom of the heel.  If you look at a typical person, they have the heel and on the upper back part of the heel is where the Achilles tendon attaches. On the bottom of the heel is where the plantar fascia attaches.  On the back of the leg are a lot of muscles that go around the ankle joint that cause the movement, and they insert around the foot and some of them insert around the area of the plantar fascia. All of these get tight when you’re walking with a limp due to the heel pain. If these aren't loosened up, you’ can’t adjust the way that you walk properly to reduce the pain and symptoms on the plantar fascia.  It’s very, very effective and very helpful to do deep tissue massage to the back of the calf, and that may be professional massage, it could be using the Graston technique with a physical therapist or the trigger point tools to get into the back into the leg. Plain stretching, I think, can have its place, but I don’t find it as beneficial as the deep tissue massage.

To Your Health,
Dr. Donald Pelto

What should a primary care doctor recommend for patients with heel pain?



Many patients in Worcester, Massachusetts come to us after seeing their primary care.  All of them that I speak to, the primary care says, when the patient comes in with help pain, take an anti-inflammatory and do some stretching and get some new shoes. Those are the top three things that they recommend after they have heel pain. In my opinion, for a primary care, it may be beneficial to add to those three things to start using a foam roller or do deep tissue massage or Graston technique to the back of the calf, either by yourself or with physical therapy, or with some tools called the trigger point tools.  I would also recommend icing with a bottle of water, putting it in the freezer, a nice stable shoe and maybe an over-the-counter insert that will give you some extra cushion in the arch, but if it doesn't get better within two or three weeks, I would have them follow-up with a podiatrist so you can get a cortisone injection, unless they are wanting to do a cortisone on their own.  In my opinion, those things working together can make people with heel pain get better the quickest.

To Your Health,
Dr. Donald Pelto