Heel Pain Needs More Than a Shot!

Thursday, 07 September 2017 19:34

heel pain01Podiatry is a rapidly changing profession. The way things are treated now is sometimes very different than the way they were treated 20 or 30 years ago. And that’s part of the problem.

Sometimes it seems that in our zeal to embrace the latest innovations we have forgotten the basics of treatment that solved most things and served as the foundation of further extensive treatment. What am I talking about?

Lately I have had patients suffering from heel pain who have been to practitioners whose entire treatment consisted of  injections and oral anti-inflammatories. Occasionally a nightsplint or stretching would be recommended. These patients had never been taped and their shoes had not been evaluated. A few of them had rigid orthotics made which they all hated. One had an expensive injection of PRP which was not covered by insurance and had no effect.

Expecting these treatments to work is like asking a toddler to run a marathon! You have to go through the basics of learning to walk and run before you can run a marathon. I believe in using simple, basic treatments that address the underlying mechanical problem of heel pain before trying anything exotic.

We measure the tightness in the Achilles tendon. If the Achilles tendon is tight we emphasize stretching and a nightsplint.  We even ask if a person sleeps on their stomach because, believe it or not, that has an effect on the Achilles tendon. (I know from personal experience.) The structure of your foot and how you walk also has a major effect. Taping of the foot and shoe modification with soft orthotics as well as stretching of the Achilles tendon are some of the most basic and effective treatments for this problem. I believe that heel pain is primarily a (bio)mechanical problem and the mechanical problem must be addressed. There is no need to do more than simple mechanical treatments if those things work and the fact is that they work a high percentage of the time! If the simple things are not enough to cure the heel pain we have had tremendous success using low energy shock wave therapy. It is a noninvasive and inexpensive treatment with a high success rate.

It is important to embrace the new yet not forget the simple, effective, tried-and-true treatments!

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