In treating heel pain, I find that there are three stages in getting better, and I explain this more in my heel treatment protocol. Usually it’s the initial stage, which is used to reduce the inflammation and loosen up the back of the calf and also stabilize the heel. If that doesn't work, then we go on to the next stage for treatment, and that involves usually something called a Dynasplint or a CAM boot, that’s to help stretch out the area more or to protect the area, and then the third aspect would go on to some type of a surgical procedure. For the most part we are able to avoid that as much as possible with our current treatment. So those are the three stages for treating heel pain. To Your Health, Dr. Donald Pelto
Many people, when they have heel pain, they search the internet because they are in need of getting better quickly because of the amount of pain. Many people go through pain and suffering and they spent a lot of money on these devices they can find online, but they don’t get any results. I’m going to explain what heel treatment protocol tends to work best for my patients most of the time. There are about 100 different products you can buy to get better from heel pain, but they focus around these three treatment options, these three modalities of treatment. I am going to go into the ones that work best for me and then I’m going to expand a little bit about the other things that you can maybe find online to buy, but may not be necessary to buy. First is reducing inflammation. Reducing inflammation, I find, works very good because you’re having pain down the heel, you have to reduce the inflammation, because what happens is every time you get up, you re-irritate the plantar fascia, it irritates it, starts a pain circle and then you stretch it out a little bit, it feels a little bit better, then you sit down, it tightens up, and when you get up it inflames it again. So you have to break that cycle. Usually when the people come in, I give them a cortisone injection to break the cycle, and then I have them ice it with a bottle of water twice a day by rolling it on the bottom of the foot for about five minutes, and use an anti-inflammatory, whether it be Motrin, ibuprofen or something prescribed, or even a prednisone dose pack that can help the inflammation. When you look online, you’re going to find many other things that may be used for heel pain. There’s different ice packs, there’s different medications, there’s different natural herbs and roots they recommend, there are different pain relieving creams. There’s hundreds of different things that you can find to reduce the inflammation around the area, but I find that those three work very well; ice, anti-inflammatory and cortisone injections. Start with those. Those are the ones that work well. The next aspect is to reduce the tightness in the back of the calf. That’s going to be essential to get rid of the heel pain. Most people try stretching. When people come into the office, I usually recommend one of two things. I recommend utilizing trigger point tools. You can find that at tptherapy.com. Use the grid or the back of the calf pack, working that out on their own at home twice a day, once in the morning when they get out of bed and then once at the end of the day after their activity. If that doesn't work, then I send them to skilled physical therapy for a treatment called Graston technique. It involves rubbing down a piece of metal on the back of the calf to loosen up any of the adhesions in that area. It’s very, very effective to reduce the pain. If you look online, you’re going to find hundreds of things. You’re going to find night splints that you can buy, that I do use, but I find that the trigger point tools work better. You’re going to find a Strasberg sock to help stretch it out. You’re going to find different types of taping activities. You’re going to find different types of massagers for the back of the calf. You’re going to find a lot of different things that all focus on working out the stretching in the back of the calf. I find that these two things work the best, the trigger point tools or physical therapy, so try to start with those and if they don’t work then you can do some of the other things. Another thing is something to strap the bottom of the heel or a little compression sock on there. All of those are used to just kind of hold in everything. They can be helpful, but I find that these other things tend to work better. The third thing is to correct the heel alignment and I find what works best for correcting heel alignment is a nice stable sneaker and a custom orthotic that helps correct the heel position, if there is any abnormality in your heel position. What you find are tons of over-the-counter arch supports. Some say that they correct the heel position, but if they’re not professionally made to hold the heel in the right position, they’re not going to really do it. They’re going to give a nice stable arch maybe, but they’re probably not going to be holding everything correctly in the heel. The keystone of the foot is holding the heel in proper position. You’re going to find a lot of other arches, a lot of pads, a lot of cushions, anything you can imagine to put in the bottom of the shoe, but what I find most effective is a nice stable sneaker like an Asics or a New Balance, you’re probably looking to pay about $100 or $120 for them, getting them from a professional shoe store, and then a custom orthotic if that doesn't work. That’s going to correct your heel alignment. Those are the two most effective things. All these other things are going to cost you money, so just be aware of buying those things. There are a hundred types of treatments out there. I find that these are the most effective for getting people better fast. To Your Health, Dr. Donald Pelto
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.
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
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.
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
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.