Heel Pain (Part Three)

Cortisone injections: Cortisone is a type of steroid, a very powerful anti-inflammatory. It can be injected into the plantar fascia to reduce inflammation and pain. Your doctor may limit cortisone injections as multiple steroid injections can cause a rupture - tear in the fascia, which can lead to flat feet and chronic pain.

Supportive Shoes and Orthotics. Shoes with thick heels and additional insoles can reduce pain when you are standing or walking. When you take steps and your heel hits the ground, a considerable amount of tension is applied to the fascia, which causes microtrauma (small tears in the fascia). A shoe with insoles or inserts reduces this tension and the microtrauma that occurs with every step. Soft silicone heel pads are inexpensive and slightly raise the insole and consequently your heel. Shoe inserts are also useful.

Night Splints. Most people sleep with their feet pointed downwards. This relaxes the plantar fascia and is one of the reasons for heel pain in the morning. A night splint stretches the plantar fascia while you sleep. Although it may be difficult to sleep with it, such a night splint is very effective and is no longer necessary once the pain has disappeared.

Physical Therapy. Your doctor may suggest that you go to a physiotherapist to work on an exercise program that focuses on the calf muscles as well as the plantar fascia. In addition to exercises like those mentioned above, a physical therapy program may include specialized treatments with ice, massage, and medications to reduce inflammation around the plantar fascia.

Extracorporeal Shockwave Therapy (ESWT). During this procedure, high-energy shockwave impulses stimulate the healing process in the damaged tissues of the plantar fascia. ESWT has not shown consistent results and therefore is not routinely applied.

ESWT is noninvasive—it does not require surgical incision. Due to the minimal risk involved, ESWT may be considered to be tried sometimes before surgery.

Surgical Treatment
Surgery is considered after 12 months of aggressive non-surgical treatment.

Gastrocnemius Recession. This is a surgical technique consisting of lengthening the gastrocnemius muscles (calf muscles). Because tight calf muscles increase stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of stretching exercises for the calf muscles.

In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase ankle movement. The procedure can be performed with a traditional, open incision or with a small incision with the help of an endoscope that contains a small camera and instrument. Your doctor will discuss the procedure that best fits your needs.

The rate of complications from gastrocnemius recession is low, but may include nerve damage.

Plantar Fascia Release. If you have normal ankle movement and persistent heel pain, your doctor may recommend a partial release procedure. During the surgery, part of the plantar fascia ligament is cut to relieve tension in the tissues. If you have a significant heel spur, it will also be removed. Although the surgery can be performed endoscopically, it is more difficult than with an open incision. Additionally, endoscopy has a higher risk of nerve damage.

Complications: The most common complications of release surgery include partial relief of pain and nerve damage.

Recovery. Most patients have good results from the surgery. However, because the surgery can result in chronic pain and discomfort, it is recommended only after all non-surgical measures have been exhausted.