As we discussed in the previous article the most important component in eliminating heel pain I believe is stretching. Take a belt, a towel, or that ugly tie Aunt Sallie gave you for your birthday and stretch your feet everyday BEFORE getting out of bed. Put the towel at the ball of the foot and pull both sides toward you like a horse bridle while keeping your knee straight. You should feel a pulling sensation behind your knee and down your leg. Hold this position for 30 seconds and repeat five times with 30 seconds rest between each stretch. Oh, and make sure you stretch the unaffected side as well. I’ve seen it go away on one foot only to return on the other.
Another trick is to freeze a regular ole’ bottle of water. Every night as your sitting in front of your television watching the news, roll that bottle with your foot for about ten minutes on each foot. This ices the bottom of the foot and stretches the fascia at the same time.
Non steroidal anti-inflammatories, or NSAIDs for short, are also a great option for some. Advil, aleve, celebrex, naprosyn, ibuprofen, motrin, etc. are over the counter and readily accessible for all patients. Your doctor may prescribe a more potent NSAID but they all help to reduce inflammation and swelling associated with this condition.
I can’t encourage you enough to wear shoes at all times, not just at work or play. Many houses have tile or wooden floors which will not offer any cushion to that painful heel of yours. Wear supportive sandals or thick flip flops around the house. I try to discourage house slippers because they are really not helpful. I prefer that my patients wear Crocs because they feel wonderful and offer just enough support to be worn around the house. Along that same line, I can’t over emphasize the importance of quality shoe gear. A good supportive shoe will do wonders. You cannot believe the type of shoes out there and I often find myself asking “you paid HOW MUCH for those?”
Moving into the doctor’s office, we have a variety of more in depth treatment options. Any good doctor worth his weight will give you a crash course on the conservative treatment options above. He may also offer to tape your feet, temporarily lifting the arch and assisting that rubber band. This works great but unfortunately, unless your doctor is your spouse, only lasts a few days because the tape falls off.
Night splints are somewhat expensive but they also work wonders. Maintaining the stretch on the plantar fascia during the night while you sleep certainly assists with pain control and condition remedy, but they can be awkward and some people may not be able to tolerate them. Your doctor may elect to have you wear a removable walking cast or boot that can be used to keep your foot immobile for a few weeks to let it rest up and heal (pun intended). Another item that can provide very long lasting relief is custom orthotics. They are expensive but ask anyone who has a pair, they are definitely worth it. These address the underlying structural abnormalities that may be contributing to your heel pain.
Injections seem to be the mainstay of our treatment regimen because they provide quick relief. They can be somewhat painful when administered, but offer long lasting relief when they take affect. They are usually composed of a short acting local anesthetic as well as a longer acting corticosteroid, which serves to reduce the inflammatory response.
You may also look into shockwave therapy which has been shown to have excellent results. As a last resort, surgery is an enticing option for some. More than 90% of patients routinely achieve lasting relief without surgery. You should try at least six months of conservative measures before entertaining the idea of surgery. Your foot and ankle surgeon will discuss the most beneficial approach for you.
No matter what treatment you undergo or receive for this sometimes very painful condition, remember that the underling causes of this condition often remain. Therefore, you should proceed with preventative measures to reduce the chance for recurrence. For all patients, wearing supportive shoes and using your custom molded orthotic devices will provide long term treatment.
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