Diagnosis of Heel Pain
Diagnosis of heel pain may involve a history of symptoms, a physical examination, and imaging tests (e.g., x-rays, ultrasound, magnetic resonance imaging [MRI] scan). Imaging tests are used to detect heel spurs, stress fractures, and hardened deposits (calcifications) that may contribute to heel pain.
Treatment for Heel Pain
Heel pain is difficult to cure and often takes months to subside, but most cases can be resolved using conservative treatment methods. Conservative treatment includes the following:
- Avoiding activities that worsen the condition (e.g., prolonged standing, strenuous exercise)
- Applying ice to the area to reduce pain and inflammation
- Wearing well-cushioned shoes that fit properly
Orthotics and shoe inserts can provide proper support, correct misalignment and imbalance in the foot, and alleviate pressure on heel spurs. Anti-inflammatory medications such as ibuprofen may be used to reduce pain and inflammation. Physical therapy also may be used to relieve heel pain.
Podiatrists may administer corticosteroid injections to reduce painful inflammation in the heel. Corticosteroid injections can be painful, and a technique called ionophoresis may be used instead to produce similar results with less pain. In this procedure, an electrical charge is applied to the area and pulls the medication through the skin. Injections also may be given with ultrasound guidance and are less painful under these circumstances due to the precise delivery of medication to the affected area.
A rigid splint may be worn on the foot to keep it at a 90-degree angle during sleep. This prevents the muscles from tightening, reduces strain on the plantar fascia in the morning, and allows healing to occur in the lengthened position. In some cases, a walking cast is worn for about 5 weeks.
Extracorporeal shock wave therapy (ESWT) is a noninvasive surgical procedure that uses sound waves to treat chronic heel pain. This outpatient procedure takes about 30 minutes and is usually performed under general anesthesia.
ESWT is not used to treat some types of heel pain (e.g., rheumatoid arthritis, infections, tarsal tunnel syndrome) and the procedure is contraindicated in patients who have a bleeding disorder and those who take blood-thinning medications (e.g., warfarin, heparin). This treatment may not be covered by insurance.
Most patients are able to resume normal activity the day after receiving extracorporeal shock wave therapy. Heavy lifting and strenuous exercise should be avoided for 4–6 weeks. Side effects include bruising, mild pain, numbness, tingling, and swelling.
Conventional surgery may be necessary to treat severe heel pain that does not resolve or that continues to worsen after 6 months of treatment. Surgery for heel pain may involve release of the plantar fascia by endoscopic methods or surgical removal, or surgical removal of a heel spur or bursa (fluid filled sac).
The procedure to release the plantar fascia is performed through a small incision in the side or bottom of the foot. The surgeon cuts the fascia, and possibly the flexor digitorum brevis muscle, so that it no longer pulls on the heel bone. If a heel spur is present, it is removed.
Following surgery, the structures that maintained the arch of the foot may no longer function properly, and the arch is weaker and may flatten. In this case, imbalances in the structure of the foot can develop, causing hammertoes or bunions. Orthotics should be used to provide extra support and keep the foot properly aligned.