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