Will my heel pain ever go away ? (Part1) Short answer: Yes (if treated early) ! Follow what worked for thousands of my patients below:

*Your heel hurts getting out of bed every morning and every time you get up after sitting for a while. It’s so painful after standing on it all day . You’ve bought insoles , took ibuprofen , limped, tried heel pads , stretches ect. Sound familiar?

There are many causes of heel pain so it is recommended to get proper diagnosis from your podiatrist. For the purposes of this post, I will focus on the dreaded plantar fasciitis.

**Also, I will focus on plantar fasciitis that has been present for at least 3 months but NOT recalcitrant to conservative treatment by a podiatrist.

See my previous post describing what the plantar fascia is and what it does :

https://dr-gaffney-best-foot.com/2023/03/16/why-your-heel-hurts-first-thing-in-the-morning-and-2-easy-ways-that-can-fix-it/

DIAGNOSIS:

First , it is important that the diagnosis of plantar fasciitis is confirmed by a podiatrist. Things like heel stress fractures , infection, gout, or autoimmune conditions ect. should not be missed.

That said the pathognomonic sign (tell tale sign ) of plantar fasciitis is pain at bottom of heel with initial weightbearing when getting out of bed in the morning that goes away after walking for a while.

There is normally point tenderness with pressure from a finger ( called palpation) at the plantar medial heel as seen below:

This is the main area where the plantar fascia band inserts .

This plantar fascia is a long triangular ligamentous type structure with the base of the triangle originating at the ball of the foot, and the points of the triangle inserting into the heel bone. So there is a lot of tension where it inserts at the point of the triangle at the heel bone.

(Clemente,Carmine . sole of right foot. illustration. 1987. Regional Atlas of the Human Body . )

If there has been even just a 10 pound weight gain within 6 months or working a weightbearing job with poorly supportive shoes on weak feet, then one has prime conditions to strain the plantar fascia ..

Early on, within the first month , there is an inflammatory response . Then the process turns into a chronic micro-trauma and reparative process that can cause thickening of the insertion site .

The thicker the insertion site gets, the more resistant to treatment so it’s important to treat early .

It will not go away .

What to do ?

1. STRETCH … A LOT

I recommend plantar fascia stretches at least 3 set of 10 holding for 10-20 seconds twice daily .

Do any variation from pictures below:

I like this stretch against the wall because it can be done anywhere.

Do Not stretch to the point of pain . If the degree of stretch is painful then back off on your pull and stretch at the non -painful point.

2. GET A NIGHT SPLINT

This helps greatly with morning heel pain.

This will stretch your plantar fascia as you sleep. .

Here is a decent one from Amazon:

https://www.amazon.com/dp/B0CHRZP18D/?tag=drgaffneybestfoot-20

(As the Amazon associate, I earn from qualifying purchases.)

Some of my patients could not sleep with this . If one cannot sleep with it on , it can still be worn while sitting during the day and will provide a benefit. .

3. STRENGTHEN the MUSCLES in the foot and massage the plantar fascia

There are FOUR layers of muscles in the sole of your foot !

Do towel crunches with your toes with foot on the ground .

Ankle pumps and rolls non-weight bearing can help build these muscles and take strain off the plantar fascia.

Doing 5-10 minutes of these exercises every other day should be helpful.

Use a golf ball and massage the plantar fascia by sitting in chair and rolling foot on top of golf ball.

4. ICE the HEEL 10 minutes at the end of your day

5. REST

Take a break from weight-bearing exercise. Switch to biking, swimming, or non-weightbearing strength training .

If possible, ask for light -duty at work.

Do this until heel pain resolves.

6. SUPPORT the plantar fascia

OTC orthotic insoles :

They cost around $30-35 and are sold on Amazon.

https://www.amazon.com/dp/B000FPKUZ0/?tag=drgaffneybestfoot-20

Orthotics take up room in the shoe so the shoe insole may need to come out to make room for it.

Orthotics also require a break in period so wear an hour first day and increase by an hour daily until wearing all day without discomfort. One can take the adjustment slower or faster depending on how it feels.

Be aware that your heel may be too inflammed to tolerate orthotics just yet and as the inflammation is reducing you may need to use an arch strapping or arch binder instead .

Here’s a video from my you tube channel showing you how to apply this strapping to yourself.

One can apply this to oneself . The cross pieces aren’t necessary but will give more support .

The support component is important in treatment to alleviate the strain or tension of the plantar fascia on the heel bone.

I recommend while treating the plantar fasciitis not to go in barefeet stocking feet nor slippers . Use slide on sneakers such as Easy Spirits with your orthotics or vionic sandals , oofas , Birkenstocks alone (no orthotics) for house shoes.

7. RESOLVING the INFLAMMATION

When this is done successfully, the pain resolves.

Icing helps.

Since topical anti-inflammatory medication such as voltaren gel has become available, I almost always use these topical medications over oral pills.

There is much less incidence of side effects with topical medications because voltaren gel only has a 6 % systemic adsorption. However, side effects such as gastric upset, blood pressure elevation or side effect to the kidneys can happen but rarely. It is not recommended to use topical anti-inflammatory medications with oral anti-inflammatory medications like Motrin/ ibuprofen, mobic , naproxen nor with blood thinners such as plavix . Also if one is allergic to any anti-inflammatory medications, voltaren gel should not be used .

The nice thing about voltaren gel is that it is now over the counter and it works very well for certain inflammatory conditions in the feet.

If using voltaren gel twice daily for 2 weeks along with the other treatments stated above does not change the pain, at this point I would offer my patients either a medrol dose pack (prednisone or oral steroid ) or a cortisone injection into the heel.

Cortisone injections for plantar fasciitis work like magic and can almost instantly take away the pain. Sometimes however it takes a couple days . I always tell my patients that it will give a false sense of security and not to forget to do the other treatments. Otherwise, the pain will recur.

I have seen a lot of patients extremely afraid of heel injections and on the other extreme, patients not bothered at all with a heel injection.

Waiting a week to let inflammation reduce doing the other treatments is helpful in tolerating a heel injection . If you have extreme needle anxiety, get a lidocaine patch over the counter (if you are not allergic to lidocaine ) and apply to heel bottom and sides one hour before appointment for the injection . Also you could ask the doctor for a Valium ahead of time .

The injection is best tolerated when given in the side as the picture above showing where the pinpoint plantar fascia pain is.

The effect from the cortisone will usually last about a month so it is important to continue the other treatments.

8. PREVENTING RECURRENCE

Determine what started the problem to begin with and institute changes: Weight gain or inflammatory diet?: Get with a health coach to help you shed pounds and institute a healthy lifestyle.

Bad shoes? Overdoing exercise or work ? Fix it.

I instruct my patients to continue with orthotics support, once daily stretching , and using a night splint once a week after pain resolves for about 3 months then slowly try to wean off these treatments. But be very cognizant to one’s feet and if any twinges occur, re-institute the treatments.

Keeping the foot muscles strong after the pain resolves is important. So continuing the foot exercises and perhaps doing yoga would keep them strong.

This is what has helped so many of my patients . I hope this helps you!

Part II of this post will be upcoming regarding treatment resistant plantar fasciitis .

Thanks for reading !

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