Heel Pain Syndrome (Plantar Fasciitis)
At the Precision Foot and Ankle Center our treatment methods for heel pain are in a step wise approach. We start with the simplest techniques and sometimes more complicated treatments are necessary. More than 80% of our patients are able to eliminate their pain without the need for surgery. Not one type of treatment will resolve your symptoms, it takes a combination of different types of treatment to alleviate your pain.
Step 1: Appropriate Shoes, OTC Orthotics, Stretching Exercises,
Anti-inflammatory Meds, Ice, Avoid Walking Barefoot,
Weight Loss, Topical Herbal Gel
See shoe recommendation list (ie. New Balance, Asics, Ecco, Mephisto, Clarks)
Remove the insole that comes with your shoe and replace it with the new OTC arch support (ie. Superfeet, Powerstep, Spenco Crosstrainers) An air heel gauntlet is an alternative to this. It is worn in the day time only and alleviates pressure and tension on the plantar fascia and arch. It is a temporary device which lasts 3-4 weeks.
When stretching keep the heel flat on the ground and the back leg straight. Hold this position without bouncing for 1 minute. This should be done when you first get out of bed in the morning, before you go to sleep and before or after any type of exercise.
Always take the anti-inflammatory pill with food every day for a minimum of 3 weeks even if the heel or arch pain is minimal, If you have any stomach discomfort stop the medication immediately and call the office. If you have stomach problems consider an oral herbal anti-inflammatory (ie. Traumeel or Zeel)
Ice helps to reduce inflammation. Apply the ice bag or a frozen bag of vegetables (ie. Peas or corn) to the heel for 15 minutes 2-3 times a day.
Barefoot walking, sandals, and slippers increase stress to the fascia, arch and heel. Try to wear proper shoes as much as possible, even in your house until the pain is resolved.
Biofreeze and Cryoderm are topical herbal anti-inflammatory gels which should be applied twice a day when you first get up and prior to going to sleep. These products are not available in stores and can be purchased in our office.
Step 2: Cortisone type Injections & Tape Strapping
We use a medication called Kenalog which is similar to cortisone but safer to use.
This is used to help reduce the inflammation of the fascia. May be repeated 1-3 times
With a maximum of 3 injections in a 12 month period. Side effects are rare but include: infection, fat pad atrophy, plantar fascia rupture, or a painful steroid response. Risks are minimized with fewer injections. If painful the night after an injection, apply ice for relief. Tenderness should go away in 24-48 hours.
Taping the foot can be performed on your own. It helps to support and immobilize the foot. Often used with an injection.
Step 3: Night Splint and Physical Therapy
A night splint is a plastic splint worn on the back of the leg & bottom of the foot. This helps to stretch the plantar fascia while you are sleeping which will minimize the morning pain. Initially, use the device in the evening when watching TV or reading. You cannot walk with it or it will break. It may need to be used for 1-3 months.
Physical therapy is typically done 2-3 times a weeks for 3-6 weeks. Treatments usually include phonohoresis which is a type of ultrasound with a special anti-inflammatory gel. Other treatments will include electrical stimulation, stretching, massage, and ice.
Step 4: Custom Functional Foot Orthotics
These devices are made from a custom mold in our office. Our arch supports are all computer generated in 3 dimensions to help give you the most precise fit and correction.
Orthotics help to take tension off of the fascia and stabilize the joints of your foot which contribute to your heel and or arch pain. They are often covered by your insurance plan, but if they are not we charge $450. Additional pairs are $300.
Step 5: Cast Immobilization
May be given in conjunction with a final injection. A below knee walking cast or cam walker may be used for 4-8 weeks to help alleviate pain and break up the pain cycle.
Step 6: PRP Injections
This is a non-surgical treatment performed in the office under local anesthesia. .
Most insurances do not cover this treatment. Our office charges $500 for the procedure.
You will need to be non weight bearing for 7 days after the procedure and then return to full walking activities. Full recovery may not be for 4-6 weeks.
Step 7: Surgical Repair
Open heel surgery is only performed by our staff of surgeons if there is a large spur and or nerve involvement. If an open procedure is performed the recovery period is typically 10-14 weeks. You will be non-weight bearing for the first 6 weeks.
Our doctors specialize in minimal incision heel surgery. This may be performed with an endoscopic technique or other specialized equipment depending on the surgeon.
Full recovery is usually 8-10 weeks but you should be able to walk on the foot after 2-3 weeks.